Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act
This bill addresses various programs, benefits, and services provided by the Department of Veterans Affairs (VA), including those related to health care, educational assistance, home loans, homelessness, and disability and memorial affairs.
Among other elements, the bill
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8371 Introduced in House (IH)]
<DOC>
118th CONGRESS
2d Session
H. R. 8371
To make certain improvements in the laws administered by the Secretary
of Veterans Affairs, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 14, 2024
Mr. Ciscomani (for himself, Mr. Ellzey, Mr. Carey, Mr. Baird, Mr.
Bergman, Mr. Luttrell, Mr. Bacon, Mr. Murphy, Mr. Bost, Mrs. Kiggans of
Virginia, Mrs. Miller-Meeks, Mr. Gimenez, Mr. Williams of New York, Mr.
Edwards, and Mrs. Steel) introduced the following bill; which was
referred to the Committee on Veterans' Affairs, and in addition to the
Committees on Natural Resources, and Armed Services, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To make certain improvements in the laws administered by the Secretary
of Veterans Affairs, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Senator Elizabeth
Dole 21st Century Veterans Healthcare and Benefits Improvement Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--HEALTH CARE MATTERS
Subtitle A--Veterans Community Care Program Matters
Sec. 101. Finality of decisions by veteran and referring clinician
under Veterans Community Care Program.
Sec. 102. Outreach regarding care and services under Veterans Community
Care Program.
Sec. 103. Annual review and report on waivers of certain payment rates
under Veterans Community Care Program.
Sec. 104. Modification of requirements for standards for quality of
care from Department of Veterans Affairs.
Sec. 105. Standardized process to determine eligibility of covered
veterans for participation in certain
mental health treatment programs.
Sec. 106. Improvements to Department of Veterans Affairs Mental Health
Residential Rehabilitation Treatment
Program.
Sec. 107. Pilot program to improve administration of care under
Veterans Community Care Program.
Sec. 108. Pilot program on consolidating approval process of Department
of Veterans Affairs for covered dental
care.
Sec. 109. Strategic plan on value-based health care system for Veterans
Health Administration; pilot program.
Sec. 110. Plan on adoption of certain health information standards for
Department of Veterans Affairs and certain
health care providers.
Sec. 111. Report on use of value-based reimbursement models under
Veterans Community Care Program.
Sec. 112. Inspector General assessment of implementation of Veterans
Community Care Program.
Sec. 113. Comptroller General report on dentistry under Veterans
Community Care Program.
Subtitle B--Matters Relating to Nursing Home and Other Long Term Care
and Family Caregivers
Sec. 120. Increase of expenditure cap for noninstitutional care
alternatives to nursing home care.
Sec. 121. Coordination with Program of All-Inclusive Care for the
Elderly.
Sec. 122. Authority for Secretary of Veterans Affairs to award grants
or contracts to entities to improve
provision of mental health support to
family caregivers of veterans.
Sec. 123. Home- and community-based services: programs.
Sec. 124. Coordination with assistance and support services for
caregivers.
Sec. 125. Improvements to program of comprehensive assistance for
family caregivers.
Sec. 126. Improvements relating to Homemaker and Home Health Aide
program.
Sec. 127. Pilot program to furnish assisted living services to certain
veterans.
Sec. 128. Provision of medicine, equipment, and supplies available to
Department of Veterans Affairs to State
homes.
Sec. 129. Recognition of organizations and individuals to assist
veterans, family members, and caregivers
navigating programs and services of
Veterans Health Administration.
Sec. 130. Reviews and other improvements relating to home- and
community-based services.
Sec. 131. GAO report on mental health support for caregivers.
Sec. 132. Development of centralized website for program information.
Sec. 133. Definitions.
Subtitle C--Medical Treatment and Other Matters
Sec. 140. Quarterly report on referrals for non-Department of Veterans
Affairs health care.
Sec. 141. Elimination of certain requirements for certain Department of
Veterans Affairs Assistant Under
Secretaries.
Sec. 142. Modification of pay limitation for physicians, podiatrists,
optometrists, and dentists of Department of
Veterans Affairs.
Sec. 143. Reimbursement of ambulance cost for care for certain rural
veterans.
Sec. 144. Pilot program to furnish dental care from the Department of
Veterans Affairs to certain veterans
diagnosed with ischemic heart disease.
Sec. 145. Documentation of preferences of veterans for scheduling of
appointments for health care under laws
administered by Secretary of Veterans
Affairs.
Sec. 146. Staffing model and performance metrics for certain employees
of the Department of Veterans Affairs.
Sec. 147. Online health education portal for veterans enrolled in
patient enrollment system of Department of
Veterans Affairs.
Sec. 148. Limitation on detail of directors of medical centers of
Department of Veterans Affairs to different
positions.
Sec. 149. National Veteran Suicide Prevention Annual Report.
Sec. 150. Report on physical infrastructure required by medical
facilities of Department of Veterans
Affairs to provide dental care services.
Sec. 151. Comptroller General report on certain oral health care
programs under laws administered by
Secretary of Veterans Affairs.
Sec. 152. Review of workflows associated with processing referrals
between facilities of the Veterans Health
Administration.
Sec. 153. Plan for timely scheduling of appointments at medical
facilities of Department of Veterans
Affairs.
Sec. 154. Authorization of appropriations to support initiatives for
mobile mammography services for veterans.
TITLE II--ECONOMIC OPPORTUNITY MATTERS
Subtitle A--Educational Assistance
Sec. 201. Temporary expansion of eligibility for Marine Gunnery
Sergeant John David Fry Scholarship.
Sec. 202. Removal of expiration on entitlement to Marine Gunnery
Sergeant John David Fry Scholarship for
surviving spouses.
Sec. 203. Sole liability for transferred educational assistance by an
individual who fails to complete a service
agreement.
Sec. 204. Notice to educational institutions of risk-based surveys.
Sec. 205. Relationship of participation by an educational institution
in certain Federal student financial aid
programs to approval of such institution
for purposes of Department of Veterans
Affairs educational assistance programs.
Sec. 206. Expansion of Department of Veterans Affairs oversight of
certain educational institutions.
Sec. 207. Requirement that educational institutions approved for
purposes of Department of Veterans Affairs
educational assistance programs provide
digital official transcripts.
Sec. 208. Payment of full monthly housing stipend for veterans enrolled
in final semester using educational
assistance under Post-9/11 Educational
Assistance Program.
Sec. 209. Modification of rules for approval of commercial driver
education programs for purposes of
educational assistance programs of the
Department of Veterans Affairs.
Sec. 210. Provision of certificates of eligibility and award letters
using electronic means.
Sec. 211. Retroactive effective date of law regarding charge to
entitlement to educational assistance for
individuals who do not transfer credits
from certain closed or disapproved programs
of education.
Sec. 212. Department of Veterans Affairs high technology program.
Sec. 213. Notice of changes to Department of Veterans Affairs policies
and guidance affecting the educational
assistance programs of the Department.
Sec. 214. Payment of VA educational assistance via electronic fund
transfer to a foreign institution of higher
education.
Sec. 215. Improving transparency and accountability of educational
institutions for purposes of veterans
educational assistance.
Subtitle B--Employment and Training
Sec. 221. Improvements to reemployment rights of members of the Armed
Forces.
Sec. 222. Review of investigations manual of Veterans' Employment and
Training Service.
Sec. 223. Warrior Training Advancement Course.
Subtitle C--Home Loans
Sec. 231. Improvements to program for direct housing loans made to
Native American veterans by the Secretary
of Veterans Affairs.
Sec. 232. Native community development financial institution relending
program.
TITLE III--DISABILITY AND MEMORIAL AFFAIRS MATTERS
Sec. 301. Burial allowance for certain veterans who die at home while
in receipt of hospice care furnished by
Department of Veterans Affairs.
Sec. 302. Authority for Secretary of Veterans Affairs to award grants
to States and Indian Tribes to improve
outreach to veterans.
Sec. 303. Definition of surviving spouse.
Sec. 304. Ensuring only licensed health care professionals perform
medical disability examinations under
certain Department of Veterans Affairs
pilot program.
Sec. 305. Provision of information regarding an agent or attorney to a
licensed health care professional who
performs a medical disability examination
under certain Department of Veterans
Affairs pilot program.
Sec. 306. Modernization of Department of Veterans Affairs disability
benefit questionnaires.
Sec. 307. Department of Veterans Affairs automatic processing of
certain claims for temporary disability
ratings.
TITLE IV--HOMELESSNESS MATTERS
Sec. 401. Short title.
Sec. 402. Per diem payments provided by the Secretary of Veterans
Affairs for services furnished to homeless
veterans.
Sec. 403. Authorization for Secretary of Veterans Affairs to use of
certain funds for improved flexibility in
assistance to homeless veterans.
Sec. 404. Access to Department of Veterans Affairs telehealth services.
TITLE V--ELECTRONIC HEALTH RECORD MATTERS
Sec. 501. Short title.
Sec. 502. Definitions.
Subtitle A--Electronic Health Record System and Health Information
Technology Modernization
Sec. 511. Modernization of Department of Veterans Affairs electronic
health record system and health information
technology.
Sec. 512. Responsibility for electronic health record program and
health information technology.
Sec. 513. Protection of personal information.
Subtitle B--Implementation Requirements
Sec. 521. Veterans Health Administration workflow baseline.
Sec. 522. Requirements for electronic health record system
implementation.
Sec. 523. Conditional restructuring of Electronic Health Record
Modernization Program.
Subtitle C--Reporting
Sec. 531. Report on additional purposes.
Sec. 532. Reports on baseline of clinical workflows.
Sec. 533. Report on health care quality metrics.
Sec. 534. Report on support strategy for existing sites.
Sec. 535. Report on resources required for future sites.
Sec. 536. Report on alternative modernization strategies.
Sec. 537. Report on health information technology strategy and roadmap.
Sec. 538. Annual report on efforts to maintain VistA electronic health
record system.
Sec. 539. Modification of quarterly reports.
Sec. 540. Report on protection of personal information.
Sec. 541. Report on organization and needs.
Sec. 542. Report on governance, performance criteria, and readiness.
TITLE VI--OVERSIGHT AND INVESTIGATIONS MATTERS
Sec. 601. Department of Veterans Affairs employee training regarding
Office of Inspector General.
Sec. 602. Annual review of security at covered facilities of the
Department of Veterans Affairs.
Sec. 603. Modification of certain housing loan fees.
TITLE I--HEALTH CARE MATTERS
Subtitle A--Veterans Community Care Program Matters
SEC. 101. FINALITY OF DECISIONS BY VETERAN AND REFERRING CLINICIAN
UNDER VETERANS COMMUNITY CARE PROGRAM.
(a) In General.--During the period specified in subsection (c), and
subject to subsection (b), an agreement under section 1703(d)(1)(E) of
title 38, United States Code, between a covered veteran and the
referring clinician of such veteran regarding the best medical interest
of the veteran is final and is not subject to review, approval, or
change by the Department of Veterans Affairs unless a statutory or
regulatory barrier prevents the Department from providing the care or
services required under such agreement.
(b) Correction of Errors.--A covered veteran and the referring
clinician of such veteran may correct any errors made with respect to
an agreement described in subsection (a).
(c) Period Specified.--The period specified in this subsection is
the two-year period beginning on the date that is 180 days after the
date of the enactment of this Act.
(d) Annual Report.--Not later than one year and not later than two
years after the commencement of the period specified under subsection
(c), the Secretary of Veterans Affairs shall submit to Congress a
report on the care provided under section 1703(d)(1)(E) of title 38,
United States Code, during the one-year period preceding the date of
the report, including--
(1) the number of instances of care provided;
(2) the type of care provided; and
(3) the cost of such care.
(e) Covered Veteran Defined.--In this section, the term ``covered
veteran'' has the meaning given that term in section 1703(b) of title
38, United States Code.
SEC. 102. OUTREACH REGARDING CARE AND SERVICES UNDER VETERANS COMMUNITY
CARE PROGRAM.
(a) Requirement.--Section 1703 of title 38, United States Code, is
further amended--
(1) by redesignating subsection (o) as subsection (p); and
(2) by inserting after subsection (n) the following new
subsection (o):
``(o) Outreach Regarding Availability of Care and Services.--(1)
The Secretary shall conduct outreach to inform veterans of the
following:
``(A) The conditions for care or services under subsections
(d) and (e).
``(B) How to request such care or services.
``(C) How to appeal a denial of a request for such care or
services using the clinical appeals process of the Veterans
Health Administration.
``(2) Upon enrollment of a veteran in the system of annual patient
enrollment established and operated under section 1705 of this title,
and not less frequently than every two years thereafter, the Secretary
shall inform the veteran of information described in paragraph (1).
``(3) The Secretary shall ensure that information described in
paragraph (1) is--
``(A) publicly displayed in each medical facility of the
Department;
``(B) prominently displayed on a website of the Department;
and
``(C) included in other outreach campaigns and activities
conducted by the Secretary.''.
(b) Transitional Services.--Section 1144(f)(1)(B)(i) of title 10,
United States Code, is amended by inserting ``, including how to enroll
in the system of annual patient enrollment established and operated
under section 1705 of title 38 and the ability to seek care and
services under sections 1703 and 1710 of such title'' before the
semicolon.
(c) Solid Start Program.--Section 6320(a)(2)(A) of title 38, United
States Code, is amended by inserting ``, including how to enroll in the
system of annual patient enrollment established and operated under
section 1705 of this title and the ability to seek care and services
under sections 1703 and 1710 of this title'' before the semicolon.
(d) Comptroller General Report on Outreach.--Not later than two
years after the date of the enactment of this Act, the Comptroller
General of the United Stats shall submit to Congress a report on the
efforts of the Secretary of Veterans Affairs to ensure that veterans
are informed of the conditions for eligibility for care and services
under section 1703 of title 38, United States Code, including such
efforts to conduct outreach pursuant to subsection (q) of such section
(as added by subsection (a)).
SEC. 103. ANNUAL REVIEW AND REPORT ON WAIVERS OF CERTAIN PAYMENT RATES
UNDER VETERANS COMMUNITY CARE PROGRAM.
(a) In General.--Section 1703 of title 38, United States Code, is
further amended--
(1) by redesignating subsection (p) as subsection (q); and
(2) by inserting after subsection (p) the following new
subsection (q):
``(q) Annual Review and Report on Waivers of Payment Rates.--(1) On
an annual basis, the Secretary shall--
``(A) conduct a review of waivers of payment rates under
subsection (i) for Third Party Administrators to identify
whether such waivers help to alleviate community-specific
challenges, including scarcity of medical services associated
with access to health care; and
``(B) submit to Congress a report on the results of such
review.
``(2) Each report under paragraph (1)(B) shall include, with
respect to the period covered by the report--
``(A) a statement, disaggregated by region, of the total
number of waivers described in subparagraph (A) of such
paragraph requested by Third Party Administrators;
``(B) a statement of the total number of such waivers that
were--
``(i) granted by the Secretary;
``(ii) denied by the Secretary; or
``(iii) withdrawn by a Third Party Administrator;
``(C) a description of the process for the review required
under paragraph (1);
``(D) a statement, disaggregated by region, of the average
time to process such waivers;
``(E) an assessment, disaggregated by region, of the extent
to which such waivers that were granted by the Secretary
improved access to health care for covered veterans; and
``(F) a description of trends, if any, identified by the
Secretary with respect to such waivers.
``(3) In this subsection, the term `Third Party Administrator' has
the meaning given such term in section 1703B of this title.''.
(b) Deadline.--The Secretary shall submit the first report required
under subsection (q) of section 1703 of such title (as added by
subsection (a)) not later than 180 days after the date of the enactment
of this Act.
SEC. 104. MODIFICATION OF REQUIREMENTS FOR STANDARDS FOR QUALITY OF
CARE FROM DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Section 1703C of title 38, United States Code, is
amended--
(1) in subsection (a)--
(A) in paragraph (2)--
(i) by striking ``In establishing'' and
inserting ``(A) In establishing''; and
(ii) by adding at the end the following new
subparagraph:
``(B) The Secretary shall ensure that the standards for
quality established under paragraph (1) are comparable to
industry standards to ensure there is adequate data
transference between care furnished by the Department and care
furnished by a non-Department provider.'';
(B) in paragraph (3), by adding at the end the
following new clauses:
``(v) Equitable care.
``(vi) Outcomes relating to patient quality
of life.'';
(C) in paragraph (4)--
(i) by striking ``and the Centers for
Medicare & Medicaid Services'' and inserting
``the Centers for Medicare & Medicaid Services,
and the Indian Health Service''; and
(ii) by striking ``and other
nongovernmental entities'' and inserting ``and
other non-governmental entities including Third
Party Administrators''; and
(D) by striking paragraph (5) and inserting the
following new paragraphs:
``(5) When collecting, considering, and applying data related to
patient care for purposes of establishing standards for quality under
paragraph (1), the Secretary shall ensure no metric is being over or
under analyzed.
``(6) In establishing standards for quality under paragraph (1),
the Secretary shall--
``(A) utilize the most up-to-date practices for extracting
and analyzing relevant data;
``(B) utilize all relevant data available to the Secretary;
``(C) ensure the most efficient use of time and resources
related to the use of data scientists employed by the
Department; and
``(D) collaborate, as appropriate, with entities specified
in paragraph (4).
``(7)(A) Not less frequently than once every five years, the
Secretary shall update the standards for quality established under
paragraph (1) pursuant to the requirements for the establishment of
such standards under this subsection.
``(B) Not later than 30 days after any date on which the Secretary
updates, pursuant to subparagraph (A), the standards for quality under
paragraph (1), the Secretary shall submit to the appropriate committees
of Congress a report on such updated standards for quality.''; and
(2) in subsection (b)--
(A) in paragraph (1)--
(i) by striking ``Not later than 1 year
after the date on which the Secretary
establishes standards for quality under
subsection (a)'' and inserting ``Not less
frequently than once every three years''; and
(ii) by inserting ``pursuant to standards
for quality under subsection (a)'' after
``medical facilities of the Department''; and
(B) in paragraph (2), by inserting ``or updates''
after ``establishes''.
(b) Deadline for Update.--The Secretary, pursuant to paragraph (7)
of section 1703C(a) of title 38, United States Code (as added by
subsection (a)), shall make the first update to the standards for
quality established under paragraph (1) of such section not later than
the date that is five years after the date on which the Secretary
submits the report under paragraph (2) of subsection (d).
(c) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall submit
to the appropriate committees of Congress a report on how the
Secretary--
(1) has consulted with entities specified in paragraph (4)
of section 1703C(a) of title 38, United States Code, before the
date of the enactment of this Act in establishing standards for
quality under such section;
(2) has continued to consult with those entities on and
after such date of enactment; and
(3) intends to leverage data sciences to improve standards
for quality care furnished by the Department of Veterans
Affairs.
(d) Updates to Quality Care Metrics.--
(1) Initial report.--Not later than one year after the date
of the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the appropriate committees of Congress a report
on how the Secretary plans to implement the amendments made by
subsection (a).
(2) Deadline; summary report.--Not later than two years
after the date of the enactment of this Act, the Secretary
shall--
(A) implement the amendments made by subsection
(a), including by updating the standards for quality
established under section 1703C of title 38, United
States Code; and
(B) submit to the appropriate committees of
Congress a report detailing the standards for quality
updated pursuant to such amendments.
(e) Audit of Quality Care Metrics.--
(1) In general.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall enter into one or more contracts with a non-Department
entity described in paragraph (2) to conduct an audit on the
quality of care from the Department of Veterans Affairs,
including through non-Department health care providers pursuant
to section 1703 of title 38 United States Code.
(2) Non-department entity described.--A non-Department
entity described in this paragraph is an entity that--
(A) specializes in analyzing large-scale
organizational data collection and analysis efforts,
especially with respect to the health care sector; and
(B) has experience and proven outcomes in
optimizing the accuracy and comprehensiveness of data
collection and analysis related to the quality of
health care services.
(3) Elements.--The audit required under paragraph (1) shall
include the following:
(A) An assessment of the methodology used by the
Department to collect and assess data on the quality of
care furnished by the Department, including any
vulnerabilities in such methodology.
(B) An assessment of the accuracy and reliability
of the data sources used by the Department to compile
data on the quality of care furnished by the
Department.
(C) The extent to which the standards the
Department uses to assess the quality of care furnished
by the Department are--
(i) comparable with industry standards;
(ii) easily accessible to, and understood
by--
(I) veterans;
(II) employees of the Department;
and
(III) other individuals, as the
private sector entity considers
appropriate.
(D) Any recommendations of such private sector
entity with respect to improvements that the Secretary
could administer to more accurately capture the quality
of care furnished by the Department.
(4) Reports on audit.--
(A) Report on findings and recommendations.--Not
later than 60 days after any date on which a private
sector entity described in paragraph (2) completes an
audit under paragraph (1), such private sector entity
shall submit to the Secretary, the Committee on
Veterans' Affairs of the Senate, and the Committee on
Veterans' Affairs of the House of Representatives a
report that includes--
(i) the findings of such audit; and
(ii) recommendations of such private sector
entity with respect to such audit.
(B) Report on planned improvements.--Not later than
60 days after any date on which the Secretary receives
a report under subparagraph (A), the Secretary shall
submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the
House of Representatives a report on how the Secretary
plans to improve the standards for quality of care of
the Department.
(f) Appropriate Committees of Congress Defined.--In this section,
the term ``appropriate committees of Congress'' has the meaning given
such term in section 1703C of title 38, United States Code.
SEC. 105. STANDARDIZED PROCESS TO DETERMINE ELIGIBILITY OF COVERED
VETERANS FOR PARTICIPATION IN CERTAIN MENTAL HEALTH
TREATMENT PROGRAMS.
(a) Standardized Screening Process.--Not later than one year after
the date of the enactment of this Act, the Secretary of Veterans
Affairs shall establish a standardized screening process to determine,
based on clinical need, whether a covered veteran satisfies criteria
for priority or routine admission to a covered treatment program.
(b) Eligibility Criteria.--
(1) In general.--Under the standardized screening process
required by subsection (a), a covered veteran shall be eligible
for priority admission to a covered treatment program if the
covered veteran meets criteria that include, but are not
limited to, the following:
(A) Symptoms that--
(i) significantly affect activities of
daily life; and
(ii) increase the risk of such veteran for
adverse outcomes.
(B) An unsafe living situation.
(C) A high-risk flag for suicide.
(D) A determination of being a high risk for
suicide.
(E) Risk factors for overdose.
(F) Non-responsive, relapsed, or unable to find
recovery from one other course of treatment, such as
outpatient or intensive outpatient treatment.
(G) Other such criteria as the Secretary determines
appropriate.
(2) Consideration.--In making a determination under
paragraph (1), the Secretary shall consider any referral of a
health care provider of a covered veteran for such covered
veteran to be admitted to a covered treatment program.
(c) Time for Screening and Admission.--Under the standardized
screening process required by subsection (a), the Secretary shall
ensure a covered veteran--
(1) is screened not later than 48 hours after the date on
which the covered veteran, or a relevant health care provider,
makes a request for the covered veteran to be admitted to a
covered treatment program.
(2) determined eligible for priority admission to a covered
treatment program is admitted to such covered treatment program
not later than 48 hours after the date of such determination.
(d) Access Standards for Routine Admission.--The Secretary shall
include the standardized screening process under this section in the
wait time access standards for eligibility for mental health care under
section 1703(d) of such title established by the Secretary under
section 1703B of such title.
(e) Conditions Under Which Care Shall Be Furnished Through Non-
Department Providers.--If the Secretary determines a covered veteran to
be eligible for either priority or routine admission to a covered
treatment program pursuant to the standardized screening process
required by subsection (a), and the Secretary is unable to admit such
covered veteran to a clinically appropriate covered treatment program
at a facility of the Department of Veterans Affairs within the State of
residence of the covered veteran in a manner that complies with the
applicable wait time standards established pursuant to this section,
the Secretary shall offer the covered veteran the option to receive
care--
(1) at another facility of the Department; or
(2) at a non-Department facility that--
(A) can admit the covered veteran within the period
required by the applicable standards of the Department;
and
(B) is party to a contract or agreement with the
Department or enters into such a contract or agreement
under which the Department furnishes a program that is
equivalent to a covered treatment program to a veteran
through such non-Departmental facility.
(f) Sunset.--
(1) In general.--The authority of the Secretary to make a
determination under this section expires on the day that is two
years after the date of the enactment of this Act.
(2) Rule of construction.--Paragraph (1) shall not be
construed to affect a covered veteran in a covered treatment
program pursuant to a determination made on or before the date
in such paragraph.
(g) Definitions.--In this section:
(1) The term ``covered treatment program''--
(A) means a mental health residential
rehabilitation treatment program of the Department of
Veterans Affairs;
(B) a program of the Department for residential
care for mental health and substance abuse disorders;
(C) includes--
(i) the programs designated as of the date
of the enactment of this section as domiciliary
residential rehabilitation treatment programs;
and
(ii) any programs designated as domiciliary
residential rehabilitation treatment programs
on or after such date of enactment; and
(D) does not include Compensated Work Therapy
Transition Residence programs of the Department.
(2) The term ``covered veteran'' means a veteran described
in section 1703(b) of title 38, United States Code.
SEC. 106. IMPROVEMENTS TO DEPARTMENT OF VETERANS AFFAIRS MENTAL HEALTH
RESIDENTIAL REHABILITATION TREATMENT PROGRAM.
(a) Performance Metrics.--
(1) In general.--The Secretary shall develop metrics to
track, and shall subsequently track, the performance of medical
facilities and Veterans Integrated Service Networks of the
Department in meeting the requirements for--
(A) screening, under section 105 of this Act, for
the Mental Health Residential Rehabilitation Treatment
Program (in this section referred to as the
``Program'') ; and
(B) timely admission, under such screening, to the
Program.
(2) Elements.--The metrics developed under paragraph (1)
shall include metrics for tracking the performance of such
medical facilities and Veterans Integrated Service Networks
with respect to routine and priority admission under the
Program.
(b) Placement; Transportation.--
(1) Locations.--If the Secretary determines that a covered
veteran is in need of residential care under the Program, the
Secretary shall provide to the covered veteran a list of
locations at which such covered veteran can receive such
residential care that meets--
(A) the standards for screening under section 105
of this Act; and
(B) the care needs of the covered veteran,
including applicable treatment tracks.
(2) Transportation coverage.--The Secretary shall provide
transportation or pay for or reimburse the costs of
transportation for any covered veteran who is admitted into the
Program and needs transportation assistance--
(A) from the residence of the covered veteran or a
facility of the Department or authorized non-Department
facility that does not provide such care to another
such facility that provides residential care covered
under the Program; and
(B) back to the residence of the covered veteran
after the conclusion of the Program, if applicable.
(c) Considerations.--In making placement decisions under the
Program, the Secretary shall consider the input of the covered veteran
and the treating clinicians of the covered veteran, including with
respect to program specialty, subtype, or treatment track offered to
the covered veteran, and the geographic placement of the covered
veteran, including family- or occupation-related preferences or
circumstances.
(d) Appeals.--
(1) In general.--The Secretary shall develop a national
policy and associated procedures under which a covered veteran,
a representative of a covered veteran, or a provider who
requests a covered veteran be admitted to the Program,
including a provider of the Department or a non-Department
provider, may file a clinical appeal pursuant to this
subsection if the covered veteran is--
(A) denied admission into the Program; or
(B) accepted into the Program but is not offered
bed placement in a timely manner.
(2) Timeliness standards for review.--
(A) In general.--The national policy and procedures
developed under paragraph (1) for appeals described in
such paragraph shall include timeliness standards for
the Department to review and make a decision on such an
appeal.
(B) Decision.--The Secretary shall review and
respond to any appeal under paragraph (1) not later
than 72 hours after the Secretary receives such appeal.
(3) Public guidance.--The Secretary shall develop, and make
available to the public, guidance on how a covered veteran, a
representative of the covered veteran, or a provider of the
covered veteran can file a clinical appeal pursuant to this
subsection--
(A) if the covered veteran is denied admission into
the Program;
(B) if the first date on which the covered veteran
may enter the Program does not comply with the
standards established by the Department under section
1703B of title 38, United States Code for purposes of
determining eligibility for mental health care under
subsections (d) and (h) of section 1703 of such title;
or
(C) with respect to such other factors as the
Secretary may specify.
(4) Rule of construction.--Nothing in this subsection may
be construed as granting a covered covered veteran the right to
appeal a decision of the Secretary with respect to admission to
the Program to the Board of Veterans' Appeals under chapter 71
of title 38, United States Code.
(e) Tracking of Availability and Wait Times.--
(1) In general.--The Secretary shall, to the extent
practicable, create a method for tracking availability and wait
times under the Program across all facilities of the
Department, Veterans Integrated Service Networks of the
Department, and non-Department providers throughout the United
States.
(2) Availability of information.--The Secretary shall, to
the extent practicable, make the information tracked under
paragraph (1) available in real time to--
(A) the mental health treatment coordinators at
each facility of the Department;
(B) the leadership of each medical center of the
Department;
(C) the leadership of each Veterans Integrated
Service Network; and
(D) the Office of the Under Secretary for Health of
the Department.
(f) Training and Oversight.--
(1) Training.--
(A) In general.--The Secretary shall update and
implement training for staff of the Department directly
involved in the Program regarding referrals, screening,
admission, placement decisions, and appeals for the
Program, including all changes to processes and
guidance under the Program required by this section and
under section 105 of this Act.
(B) Covered veterans awaiting admission.--The
training under subparagraph (A) shall include
procedures for the care of covered veterans awaiting
admission into the Program and communication with such
covered veterans and the providers of such covered
veterans.
(C) Timing of training.--
(i) In general.--The Secretary shall
require the training under subparagraph (A) to
be completed by staff required to complete such
training--
(I) not later than 60 days after
beginning employment at the Department
in a position that includes work
directly involving the Program; and
(II) not less frequently than
annually.
(ii) Tracking.--The Secretary shall track
completion of training required under clause
(i) by staff required to complete such
training.
(2) Oversight standards.--The Secretary shall review and
revise oversight standards for the leadership of the Veterans
Integrated Service Networks and the Veterans Health
Administration to ensure that facilities and staff of the
Department are adhering to the policy of the Program on access
to care.
(g) Care Coordination and Follow-Up Care.--
(1) Continuity of care.--The Secretary shall ensure each
covered veteran who is screened for admission to the Program is
offered, and provided if agreed upon, care options during the
period between screening of the covered veteran and admission
of the covered veteran to the Program to ensure the covered
veteran does not experience any lapse in care.
(2) Care coordination for substance use disorder.--For a
covered veteran being treated for substance use disorder, the
Secretary shall--
(A) ensure there is a care plan in place during the
period between any detoxification services or inpatient
care received by the covered veteran and admission of
the covered veteran to the Program; and
(B) communicate that care plan to the covered
veteran, the primary care provider of the covered
veteran, and the facility of the Program where the
covered veteran is or will be residing.
(3) Care planning prior to discharge.--
(A) In general.--The Secretary, in consultation
with the covered veteran and the treating providers of
the covered veteran in the Program, shall ensure the
completion of a care plan prior to the covered veteran
being discharged from the Program.
(B) Matters to be included.--The care plan required
under subparagraph (A) for a covered veteran shall
include details on the course of treatment for the
covered veteran following completion of treatment under
the Program, including any necessary follow-up care.
(C) Sharing of care plan.--The care plan required
under subparagraph (A) shall be shared with the covered
veteran, the primary care provider of the covered
veteran, and any other providers with which the covered
veteran consents to sharing the plan.
(D) Discharge from non-department facility.--Upon
discharge of a covered veteran under the Program from a
non-Department facility, the facility shall share with
the Department all care records maintained by the
facility with respect to the covered veteran and shall
work in consultation with the Department on the care
plan of the covered veteran required under subparagraph
(A).
(h) Reports to Congress.--
(1) Report on modifications to program.--
(A) In general.--Not later than two years after the
date of the enactment of this Act, the Secretary of
Veterans Affairs shall submit to the Committees on
Veterans' Affairs of the House of Representatives and
the Senate a report on modifications made to the
guidance, operation, and oversight of the Program to
fulfill the requirements of this section.
(B) Elements.--The report required by subparagraph
(A) shall include--
(i) an assessment of whether costs of the
Program, including for residential care
provided through facilities of the Department
and non-Department facilities, serve as a
disincentive to placement in the Program;
(ii) a description of actions taken by the
Department to address the findings and
recommendations by the Secretary contained in
the report under section 503(c) of the STRONG
Veterans Act of 2022 (division V of Public Law
117-328), including such actions with respect
to--
(I) any new locations of the
Program added;
(II) any beds added at existing
facilities of the Program; and
(III) any additional treatment
tracks or sex-specific programs created
or added at facilities of the
Department; and
(iii) such recommendations as the Secretary
may have for legislative or administrative
action to address any funding constraints or
disincentives for use of the Program.
(2) Annual report on operation of program.--
(A) In general.--Not later than one year after the
submission of the report under paragraph (1)(A), and
not less frequently than annually thereafter during the
duration of the Program, the Secretary shall submit to
the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report on the
operation of the Program.
(B) Elements.--Subject to subparagraph (C), each
report required by subparagraph (A) shall include the
following:
(i) The number of covered veterans served
by the Program, disaggregated by--
(I) Veterans Integrated Service
Network in which the covered veteran
receives care;
(II) facility, including facilities
of the Department and non-Department
facilities, at which the covered
veteran receives care;
(III) type of residential
rehabilitation treatment care received
by the covered veteran under the
Program;
(IV) sex of the covered veteran;
and
(V) race or ethnicity of the
covered veteran.
(ii) Wait times under the Program for the
most recent year data is available,
disaggregated by--
(I) treatment track or specificity
of residential rehabilitation treatment
care sought by the covered veteran;
(II) sex of the covered veteran;
(III) State or territory in which
the covered veteran is located;
(IV) Veterans Integrated Service
Network in which the covered veteran is
located; and
(V) facility of the Department at
which the covered veteran seeks care.
(iii) A list of all locations of the
Program and number of bed spaces at each such
location, disaggregated by residential
rehabilitation treatment care or treatment
track provided under the Program at such
location.
(iv) A list of any new Program locations
added or removed and any bed spaces added or
removed during the one-year period preceding
the date of the report.
(v) Average cost of a stay under the
Program, including total stay average and daily
average, at--
(I) a facility of the Department;
and
(II) a non-Department facility.
(vi) A review of staffing needs and gaps
with respect to the Program.
(vii) Any recommendations for changes to
the operation of the Program, including any
policy changes, guidance changes, training
changes, or other changes.
(C) Anonymity.--The Secretary shall provide the
data under this paragraph pursuant to Federal laws and
in a manner that is wholly consistent with applicable
Federal privacy and confidentiality laws, including the
Privacy Act (5 U.S.C. 552a), the Health Insurance
Portability and Accountability Act (Public Law 104-191;
42 U.S.C. 201 note) and regulations (title 45, Code of
Federal Regulations, parts 160 and 164, or successor
regulations), and sections 5701, 5705, and 7332 of
title 38, United States Code, to ensure that the
provided data, or some portion of the data, will not
undermine the anonymity of a veteran.
(i) Revision of Guidance.--The Secretary shall update the guidance
of the Department of Veterans Affairs on the operation of the Mental
Health Residential Rehabilitation Treatment Program to reflect each of
the requirements under subsections (b) through (h).
(j) Deadline.--The Secretary of Veterans Affairs shall carry out
each requirement under this section by not later than one year after
the date of the enactment of this Act, unless otherwise specified.
(k) Comptroller General Review.--
(1) In general.--Not later than two years after the date of
the enactment of this Act, the Comptroller General of the
United States shall review access to care under the Program for
covered veterans in need of residential mental health care and
substance use disorder care.
(2) Elements.--The review required by paragraph (1) shall
include the following:
(A) A review of wait times under the Program,
disaggregated by--
(i) treatment track or specificity of
residential rehabilitation treatment care
needed;
(ii) sex of the covered veteran;
(iii) home State of the covered veteran;
(iv) home Veterans Integrated Service
Network of the covered veteran; and
(v) wait times for--
(I) facilities of the Department;
and
(II) non-Department facilities.
(B) A review of policy and training of the
Department on screening, admission, and placement under
the Program.
(C) A review of the rights of covered veterans and
providers to appeal admission decisions under the
Program and how the Department adjudicates appeals.
(D) When determining the facility at which a
covered veteran admitted to the Program will be placed
in the Program, a review of how the input of the
covered veteran is taken into consideration with
respect to--
(i) program specialty, subtype, or
treatment track offered to the covered veteran;
and
(ii) the geographic placement of the
covered veteran, including family- or
occupation-related preferences or
circumstances.
(E) A review of staffing and staffing needs and
gaps of the Program, including with respect to--
(i) mental health providers and
coordinators at the facility level;
(ii) staff of Program facilities;
(iii) staff of Veterans Integrated Service
Networks; and
(iv) overall administration of the Program
at the national level.
(F) Recommendations for improvement of access by
covered veterans to care under the Program, including
with respect to--
(i) any new sites or types of programs
needed or in development;
(ii) changes in training or policy;
(iii) changes in communications with
covered veterans; and
(iv) oversight of the Program by the
Department.
(l) Definitions.--In this section:
(1) The term ``covered veteran'' means a veteran described
in section 1703(b) of title 38, United States Code.
(2) The term ``Mental Health Residential Rehabilitation
Treatment Program''--
(A) means--
(i) a mental health residential
rehabilitation treatment program of the
Department under sections 103 and 104 of the
Veterans Mental Health and Other Care
Improvement Act of 2008 (Public Law 110-387);
and
(ii) the array of programs and services of
the Department that comprise residential care
for mental health and substance use disorders;
(B) includes--
(i) the programs designated as of the date
of the enactment of this Act as domiciliary
residential rehabilitation treatment programs;
and
(ii) any programs designated as domiciliary
residential rehabilitation treatment programs
on or after such date of enactment; and
(C) does not include compensated work therapy
transition resident programs of the Department.
(3) The term ``treatment track'' means a specialized
treatment program that is provided to a subset of covered
veterans in the Program who receive the same or similar
intensive treatment and rehabilitative services.
(m) Sunset.--This section shall terminate on the day that is two
years after that date on which the Secretary completes carrying out
each requirement pursuant to subsection (j).
SEC. 107. PILOT PROGRAM TO IMPROVE ADMINISTRATION OF CARE UNDER
VETERANS COMMUNITY CARE PROGRAM.
(a) Establishment.--Pursuant to section 1703E of title 38, United
States Code, the Secretary of Veterans Affairs shall carry out a pilot
program to seek to develop and implement a plan--
(1) to provide monetary and non-monetary incentives to a
covered health care provider--
(A) to allow the Secretary to see the scheduling
system of the provider, to assess the availability of,
and to assist in scheduling appointments for, veterans
under the Veterans Community Care Program under section
1703 of such title, including through synchronous,
asynchronous, and asynchronous assisted digital
scheduling;
(B) to complete continuing professional educational
training available through the VHA TRAIN program (or
any successor program or initiative) regarding veteran
cultural competency, the opioid safety initiative (or
any successor program or initiative), and other
subjects determined appropriate by the Secretary;
(C) to improve methods of accounting for non-
Department training that is equivalent or substantially
similar to the continuing professional educational
training described in subparagraph (B);
(D) to improve the rate of the timely return to the
Secretary of medical record documentation for care or
services provided under the Veterans Community Care
Program;
(E) to improve the timeliness and quality of the
delivery of care and services to veterans under such
program; and
(F) to achieve other objectives determined
appropriate by the Secretary; and
(2) to decrease the rate of no-show appointments under such
program.
(b) Report.--Not later than one year after the date of the
establishment of the pilot program under this section, annually
thereafter during the term of the pilot program, the Secretary of
Veterans Affairs shall submit to the Committees on Veterans' Affairs of
the House of Representatives and the Senate a report on the pilot
program that includes, with respect to the period covered by the
report--
(1) an assessment of the extent to which--
(A) the system of the Department of Veterans
Affairs for scheduling appointments for veterans under
the Veterans Community Care Program has improved;
(B) the rate of timely return to the Secretary of
medical record documentation described in subparagraph
(D) of subsection (a)(1) has improved;
(C) the timeliness and quality of the delivery of
care and services described in subparagraph (E) of such
subsection has improved; and
(D) the frequency of no-show appointments described
in paragraph (2) of such subsection decreased;
(2) a list of the continuing professional educational
training courses under subparagraph (B) of such subsection
available to covered health care providers;
(3) the rate of participation in such continuing
professional education training courses; and
(4) any other matter the Secretary determines appropriate.
(c) Definitions.--In this section:
(1) The term ``covered health care provider'' means a
health care provider--
(A) described in subsection (c) of section 1703 of
title 38, United States Code, that furnishes care or
services under the Veterans Community Care Program
pursuant to a contract or agreement with a Third Party
Administrator; or
(B) that otherwise furnishes care or services
outside of Department facilities pursuant to a contract
or agreement with the Secretary of Veterans Affairs.
(2) The term ``opioid safety initiative'' means the
programs, processes, and guidelines of the Veterans Health
Administration of the Department of Veterans Affairs relating
to the management of opioid therapy and chronic pain.
(3) The term ``Third Party Administrator'' means an entity
that manages a network of health care providers and performs
administrative services related to such network under section
1703 of such title.
(4) The term ``VHA TRAIN program'' means the free program
of the Veterans Health Administration that offers veteran-
specific continuing medical education courses.
SEC. 108. PILOT PROGRAM ON CONSOLIDATING APPROVAL PROCESS OF DEPARTMENT
OF VETERANS AFFAIRS FOR COVERED DENTAL CARE.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall carry
out a pilot program to hire--
(1) general dentists at medical facilities of the
Department of Veterans Affairs to manage approval by the
Department of treatment plans requested by dental providers in
providing covered dental care; and
(2) dental specialists at Veterans Integrated Service
Networks of the Department to manage approval by the Department
of treatment plans for specialty dental care requested by
dental providers in providing covered dental care.
(b) Locations.--The Secretary shall carry out the pilot program in
not fewer than two Veterans Integrated Service Networks of the
Department.
(c) Reports.--
(1) Initial report.--Not later than one year after the date
of the commencement of such pilot program, the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and
the House of Representatives a report on the pilot program,
that includes--
(A) an identification of the Veterans Integrated
Service Networks participating in such pilot program;
(B) a description of the implementation of such
pilot program;
(C) an identification of any barriers or challenges
to implementing such pilot program;
(D) an assessment of the efficacy of hiring general
dentists and dental specialists pursuant to such pilot
program;
(E) aggregated feedback with respect to such pilot
program from dentists of the Department in Veterans
Integrated Service Networks participating in such pilot
program; and
(F) aggregated feedback from dental providers
providing covered dental care within such Veterans
Integrated Service Networks regarding any changes in
the timeliness of treatment plan approvals by the
Department.
(2) Final report.--Not later than 90 days before the date
of the completion of such pilot program, the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and
the House of Representatives a report on the pilot program
that--
(A) includes, with respect to the period covered by
the report, each element of the report required under
paragraph (1) described in subparagraphs (A) through
(F) of such paragraph;
(B) includes recommendations of the Secretary on
whether the pilot program should be--
(i) extended;
(ii) expanded; or
(iii) adopted throughout the Department;
and
(C) indicates whether the Secretary requests action
by Congress to make the pilot program permanent.
(d) Sunset.--The authority to carry out the pilot program under
this section shall terminate on the date that is two years after the
date of the enactment of this Act.
(e) Covered Dental Care Defined.--In this section, the term
``covered dental care'' means dental care provided--
(1) under section 1703 of title 38, United States Code; or
(2) pursuant to a Veterans Care Agreement under section
1703A of such title.
SEC. 109. STRATEGIC PLAN ON VALUE-BASED HEALTH CARE SYSTEM FOR VETERANS
HEALTH ADMINISTRATION; PILOT PROGRAM.
(a) Establishment of Working Group.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall--
(A) establish a working group on value-based care;
and
(B) submit to the Committees on Veterans' Affairs
of the House of Representatives and the Senate the
strategic plan developed by the working group pursuant
to subsection (b).
(2) Membership.--
(A) Required members.--The working group shall
include, at a minimum, the following members:
(i) The Under Secretary for Health of the
Department of Veterans Affairs.
(ii) The Director of the Office of Mental
Health and Suicide Prevention of the Department
of Veterans Affairs (or any successor office).
(iii) The Director of the Office of
Integrated Veteran Care of the Department (or
any successor office).
(iv) The Director of the Office of Rural
Health of the Department (or any successor
office).
(v) The Director of the Office of Connected
Care of the Department (or any successor
office).
(vi) The Assistant Secretary for the Office
of Information Technology (or any successor
office).
(vii) The Chief Officer of the Office of
Healthcare Innovation and Learning of the
Office of Discovery, Education, and Affiliate
Networks of the Veterans Health Administration
(or any successor office).
(viii) An individual designated by the
Secretary from the Center for Innovation for
Care and Payment of the Department under
section 1703E of title 38, United States Code.
(ix) An individual designated by the
Administrator of the Centers for Medicare &
Medicaid Services from the Center for Medicare
and Medicaid Innovation.
(x) An individual designated by the
Secretary of Health and Human Services from the
Federal Office of Rural Health Policy of the
Health Resources and Services Administration.
(xi) The Chief of Human Capital Management
for the Veterans Health Administration.
(xii) An individual designated by the
Secretary of Defense that is a representative
of the Defense Health Agency.
(xiii) An individual selected by the
Secretary of Veterans Affairs from the special
medical advisory group established under
section 7312 of title 38, United States Code.
(B) Optional members.--The Secretary of Veterans
Affairs may appoint any of the following individuals as
members of the working group:
(i) An individual representing the Health
and Medicine Division of the National Academies
of Sciences, Engineering, and Medicine.
(ii) Three individuals representing a
private health care system that has made the
transition to value-based care.
(iii) Three individuals representing an
organization recognized by the Secretary of
Veterans Affairs under section 5902 of title
38, United States Code.
(3) Exemption from faca.--Chapter 10 of title 5, United
States Code, shall not apply to the working group established
under paragraph (1).
(b) Development of Strategic Plan.--The working group shall develop
a strategic plan to implement value-based care into the Veterans Health
Administration that includes the following:
(1) An identification of the state of the Veterans Health
Administration as of the date of the enactment of this Act,
including an assessment of the current model of health care
delivery used by the Veterans Health Administration in medical
facilities of the Department of Veterans Affairs.
(2) An assessment of the capacity needs of the Veterans
Health Administration during the five-year period beginning on
the date of the enactment of this Act.
(3) An analysis of the leadership of the Veterans Health
Administration, including an assessment of leadership acumen
and ability to implement a clear, shared vision and effective
change management and care coordination.
(4) An identification of goals for the future of the
Veterans Health Administration.
(5) An identification and classification of the current
capabilities, capacity, and gaps in access and quality of the
health care system of the Department of Veterans Affairs.
(6) An analysis of value-based care models, including--
(A) a selection of potential models that would best
work for the Veterans Health Administration;
(B) the capacity and capabilities of each such
model; and
(C) a thorough justification of the selection of
each selected model, including an summary of the
ability of such model to improve the metrics described
under paragraph (9).
(7) A definition of what quality means with respect to--
(A) access to health care under the laws
administered by the Secretary of Veterans Affairs; and
(B) delivery of such health care.
(8) A definition of what value means with respect to care
furnished by the Veterans Health Administration,
(9) A system for measuring value within the Veterans Health
Administration that includes metrics for--
(A) outcomes;
(B) safety;
(C) service;
(D) access;
(E) productivity;
(F) capacity;
(G) equity; and
(H) total cost of patient care.
(10) With respect to the system described in subparagraph
(H), an analysis of variable value with respect to patient
outcomes across different health care types and specialties.
(11) An assessment of--
(A) previous or ongoing assessments of the current
information technology infrastructure of the Veterans
Health Administration, including--
(i) such assessments conducted pursuant to
the Electronic Health Record Modernization
program of the Department of Veterans Affairs;
and
(ii) any other ongoing information
technology modernization programs of such
Department and any unimplemented relevant
recommendations from such assessments;
(B) the information technology infrastructure of
the Veterans Health Administration in effect as of the
date of the enactment of this Act;
(C) the value-driven framework of the Department,
in effect as of the date of the enactment of this Act,
for evaluating health care innovations, and how
improvements in such framework could be used to
encourage innovation; and
(D) workforce challenges and needs of the Veterans
Health Administration based on--
(i) reviews of workforce assessment data
available as of the date of the enactment of
this Act; and
(ii) the findings of--
(I) the report required by section
301(d) of the Veterans Access, Choice,
and Accountability Act of 2014 (Public
Law 113-146);
(II) the reports required by
section 505 of the John S. McCain III,
Daniel K. Akaka and Samuel R. Johnson
VA Maintaining Internal Systems and
Strengthening Integrated Outside
Networks Act of 2018 (Public Law 115-
182);
(III) the report required by
section 301 of the VA Choice and
Quality Employment Act of 2017 (Public
Law 115-46); and
(IV) any comprehensive health care
inspection conducted by the Inspector
General of the Department of Veterans
Affairs as of the date of the enactment
of this Act.
(12) Any recommendations of the working group with respect
to improving the information technology infrastructure
described in clause (i) of subparagraph (J).
(13) An analysis of how the value-driven framework
described in clause (iii) of such subparagraph could be used to
improve the model of care delivery by the Department.
(14) A description of how a value-based care system would
apply to primary care, inpatient and outpatient mental health
care, and inpatient and outpatient substance use treatment,
spinal cord injury disorder care, and polytrauma care furnished
by the Veterans Health Administration.
(15) With respect to legislative or administrative action
necessary to incorporate value-based care models into the
Veterans Health Administration, a description of the estimated
timelines, effect on workforce, and costs.
(c) Pilot Program.--
(1) In general.--Not later than 180 days after the
submission of the strategic plan pursuant to subsection (b),
the Secretary of Veterans Affairs shall commence a three-year
pilot program to implement the elements of such strategic plan
relating to the delivery, by the Veterans Health
Administration, of primary care, inpatient and outpatient
mental health treatment, inpatient and outpatient substance
abuse treatment, spinal cord injury disorder care, and
polytrauma care.
(2) Locations.--The Secretary shall carry out such pilot
program in four Veterans Integrated Service Networks that are
geographically dispersed and shall include the following:
(A) A Veterans Integrated Service Network that
predominately serves veterans in rural and highly rural
areas.
(B) A Veterans Integrated Service Network that
predominately serves veterans in urban areas.
(C) A Veterans Integrated Service Network that has
a high rate of suicide among veterans.
(D) A Veterans Integrated Service Network that has
a high rate of substance use disorder among veterans.
(E) A Veterans Integrated Service Network that has
access or productivity challenges.
(3) Reports to congress.--
(A) Annual report.--Not later than one year after
the commencement of the pilot program, and annually
thereafter during the duration of the pilot program,
the Secretary shall submit to Congress a report on the
pilot program.
(B) Final report.--Not later than 90 days before
the conclusion of the pilot program, the Secretary
shall submit to Congress a final report on the pilot
program that includes--
(i) lessons learned during the
administration of such pilot program; and
(ii) specific health outcomes in veteran
patient care compared to the Veterans Health
Administration system of care in effect as of
the date of the enactment of this Act.
SEC. 110. PLAN ON ADOPTION OF CERTAIN HEALTH INFORMATION STANDARDS FOR
DEPARTMENT OF VETERANS AFFAIRS AND CERTAIN HEALTH CARE
PROVIDERS.
(a) Plan for Certain Health Information Standards.--
(1) In general.--The Secretary of Veterans Affairs, in
consultation with the Secretary of Health and Human Services,
the Administrator of the Centers for Medicare & Medicaid
Services, and the National Coordinator for Health Information
Technology of the Department of Health and Human Services,
shall create and implement a plan to adopt, as rapidly and to
the most comprehensive extent feasible, national health
information interoperability standards for the Department of
Veterans Affairs and community care providers with respect to--
(A) coordination of--
(i) care; and
(ii) benefits;
(B) patient identity matching;
(C) measurement and reporting of quality;
(D) population health; and
(E) public health.
(2) Consideration.--In developing the plan under paragraph
(1), the Secretary of Veterans Affairs shall consider
challenges faced by--
(A) small community care providers; and
(B) community care providers located in rural
areas.
(b) Plan on Electronic Health Record Exchange.--
(1) In general.--Not later than one year after the date of
enactment of this Act, the Secretary shall submit to the
Committees on Veterans' Affairs of the Senate and the House of
Representatives a plan to provide, at no cost, to community
care providers of the Department, through Third Party
Administrators, a capability to facilitate the electronic
direct exchange, between such providers and the Department,
of--
(A) the health records of veterans; and
(B) documents relating to health care of veterans,
clinical notes, and any other information the Secretary
determines necessary.
(2) Prioritization.--In developing the plan required under
paragraph (1), the Secretary shall prioritize providing the
capability described in such paragraph to community care
providers that--
(A) provide care under the laws administered by the
Secretary to--
(i) a lower volume of veterans; and
(ii) veterans who are located in rural
areas; and
(B) are unable or unwilling to exchange the records
and documents described in subparagraphs (A) and (B) of
such paragraph with the Department through standards-
based or direct exchange mechanisms in effect as of the
date of the enactment of this Act.
(c) Reports on Plan for Interoperability Standards.--
(1) Initial report.--Not later than one year after the date
of the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives--
(A) the plan required by subsection (a); and
(B) a report that includes--
(i) an analysis of gaps, if any, between
the use, by the Department and other agencies,
health information exchanges, and technology
companies, of national health information
interoperability standards and the potential,
or optimal, use of such national health
information interoperability standards;
(ii) an analysis and description of the
participation by the Department, community care
providers, and other relevant entities in the
Trusted Exchange Framework and Common Agreement
program of the Department of Health and Human
Services as of the date of the enactment of
this Act;
(iii) recommendations of the Secretary with
respect to development of health information
interoperability standards;
(iv) timelines or schedules to implement
the plan required by subsection (a); and
(v) an identification of any legislative
authorities or resources the Secretary requires
to implement such plan.
(2) Recurring report requirement.--
(A) In general.--Not later than 18 months after the
date of the enactment of this Act, and every 180 days
thereafter for four years, the Secretary of Veterans
Affairs shall submit to Committees on Veterans' Affairs
of the Senate and the House of Representatives a report
on the status of implementation of the plan required
under subsection (a).
(B) Elements of subsequent reports.--Each report
under subparagraph (A) submitted after the date on
which the first report required by such subparagraph is
submitted shall include a description of any revisions
to--
(i) the plan required by subsection (a)
made during the period covered by the report;
and
(ii) the analysis, recommendations,
timelines, and legislative authorities reported
pursuant to paragraph (1).
(d) Definitions.--In this section:
(1) The term ``community care provider'' means a non-
Department health care provider providing care (including
dental care)--
(A) under section 1703 of title 38, United States
Code;
(B) pursuant to a Veterans Care Agreement under
section 1703A of such title; or
(C) under any other law administered by the
Secretary of Veterans Affairs.
(2) The term ``Third Party Administrator'' means an entity
that manages a provider network and performs administrative
services related to such network under section 1703 of title
38, United States Code.
SEC. 111. REPORT ON USE OF VALUE-BASED REIMBURSEMENT MODELS UNDER
VETERANS COMMUNITY CARE PROGRAM.
(a) Report on Value-Based Reimbursement Models.--Not later than one
year after the date of the enactment of this Act, the Secretary of
Veterans Affairs, in consultation with the Center for Innovation for
Care and Payment of the Department of Veterans Affairs under section
1703E of title 38 United States Code, the Office of Integrated Veteran
Care of the Department, or successor office, and Third Party
Administrators, shall submit to the Committees on Veterans' Affairs of
the House of Representatives and the Senate a report containing--
(1) an assessment of the efforts of the Department pursuant
to section 1703(i)(5) of such title, to incorporate value-based
reimbursement models under the Veterans Community Care Program
to promote the provision of high-quality care to veterans; and
(2) such recommendations for legislative or administrative
action as the Secretary considers appropriate regarding the use
of value-based reimbursement models throughout the Veterans
Community Care Program under section 1703 of such title.
(b) Rule of Construction.--This section shall not be construed to
be a pilot program subject to the requirements of section 1703E of
title 38, United States Code.
(c) Third Party Administrator Defined.--In this section, the term
``Third Party Administrator'' means an entity that manages a provider
network and performs administrative services related to such network
under section 1703 of title 38, United States Code.
SEC. 112. INSPECTOR GENERAL ASSESSMENT OF IMPLEMENTATION OF VETERANS
COMMUNITY CARE PROGRAM.
(a) In General.--Not later than two years after the date of the
enactment of this Act, and periodically thereafter, the Inspector
General shall assess the performance of a representative sample of
medical centers in each Veterans Integrated Service Network of the
Department of Veterans Affairs in--
(1) appropriately identifying veterans eligible for care
and services under section 1703 of title 38, United States
Code;
(2) informing veterans of their eligibility for such care
and services; and
(3) delivering such care and services in a timely manner.
(b) Briefing on Assessments.--Upon the submission of the initial
assessment required by subsection (a), the Inspector General of the
Department of Veterans Affairs shall provide to the Committees on
Veterans Affairs of the House of Representatives and the Senate a
briefing on the plans of such Inspector General with respect to the
findings, frequency, and methodology relating to such assessment.
SEC. 113. COMPTROLLER GENERAL REPORT ON DENTISTRY UNDER VETERANS
COMMUNITY CARE PROGRAM.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Committees on Veterans' Affairs of the Senate and
the House of Representatives a report on dental care furnished by the
Secretary of Veterans Affairs under the Veterans Community Care Program
under section 1703 of title 38, United States Code, that includes a
review of--
(1) the impact current reimbursement rates provided by the
Department of Veterans Affairs to dental providers under such
program have on--
(A) the availability of dental care for veterans;
and
(B) the ability of Third Party Administrators to
meet their contractual obligations for network
adequacy;
(2) the satisfaction of dental providers providing dental
care under such program with the processes of the Department
for approving dental care under such program; and
(3) the current processes of the Department for approving
emergent dental care under such program.
(b) Third Party Administrator Defined.--In this section, the term
``Third Party Administrator'' means an entity that manages a provider
network and performs administrative services related to such network
under section 1703 of title 38, United States Code.
Subtitle B--Matters Relating to Nursing Home and Other Long Term Care
and Family Caregivers
SEC. 120. INCREASE OF EXPENDITURE CAP FOR NONINSTITUTIONAL CARE
ALTERNATIVES TO NURSING HOME CARE.
(a) Increase of Expenditure Cap.--Section 1720C(d) of title 38,
United States Code, is amended--
(1) by striking ``The total cost'' and inserting ``(1)
Except as provided in paragraph (2), the total cost'';
(2) by striking ``65 percent'' and inserting ``100
percent''; and
(3) by adding at the end the following new paragraph:
``(2)(A) The total cost of providing services or in-kind assistance
in the case of any veteran described in subparagraph (B) for any fiscal
year under the program may exceed 100 percent of the cost that would
otherwise have been incurred as specified in paragraph (1) if the
Secretary determines, based on a consideration of clinical need,
geographic market factors, and such other matters as the Secretary may
prescribe through regulation, that such higher total cost is in the
best interest of the veteran.
``(B) A veteran described in this subparagraph is a veteran with
amyotrophic lateral sclerosis, a spinal cord injury, or a condition the
Secretary determines to be similar to such conditions.''.
(b) Applicability.--The amendments made by subsection (a) shall
apply with respect to fiscal years beginning on or after the date of
the enactment of this Act.
SEC. 121. COORDINATION WITH PROGRAM OF ALL-INCLUSIVE CARE FOR THE
ELDERLY.
Section 1720C of title 38, United States Code, as amended by
section 120, is further amended by adding at the end the following new
subsection:
``(f) In furnishing services to a veteran under the program
conducted pursuant to subsection (a), if a medical center of the
Department through which such program is administered is located in a
geographic area in which services are available to the veteran under a
PACE program (as such term is defined in sections 1894(a)(2) and
1934(a)(2) of the Social Security Act (42 U.S.C. 1395eee(a)(2); 1396u-
4(a)(2))), the Secretary shall seek to enter into an agreement with the
PACE program operating in that area for the furnishing of such
services.''.
SEC. 122. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO AWARD GRANTS
OR CONTRACTS TO ENTITIES TO IMPROVE PROVISION OF MENTAL
HEALTH SUPPORT TO FAMILY CAREGIVERS OF VETERANS.
Subchapter II of chapter 17 of title 38, United States Code, is
amended by adding at the end the following new section (and conforming
the table of sections at the beginning of such chapter accordingly):
``Sec. 1720K. Grants or contracts to provide mental health support to
family caregivers of veterans
``(a) Authority.--The Secretary may award grants to carry out,
coordinate, improve, or otherwise enhance mental health counseling,
treatment, or support to the family caregivers of veterans
participating in the family caregiver program.
``(b) Application.--(1) To be eligible for a grant or contract
under this section, an entity shall submit to the Secretary an
application therefor at such time, in such manner, and containing such
information as the Secretary may require.
``(2) Each application submitted under paragraph (1) shall include
the following:
``(A) A detailed plan for the use of the grant or contract.
``(B) A description of the programs or efforts through
which the entity will meet the outcome measures developed by
the Secretary under subsection (g).
``(C) A description of how the entity will distribute grant
or contract amounts equitably among areas with varying levels
of urbanization.
``(D) A plan for how the grant or contract will be used to
meet the unique needs of veterans residing in rural areas,
Native American, Native Hawaiian, or Alaska Native veterans,
elderly veterans, women veterans, and veterans from other
underserved communities.
``(c) Distribution.--The Secretary shall seek to ensure that grants
and contracts awarded under this section are equitably distributed
among entities located in States with varying levels of urbanization.
``(d) Priority.--The Secretary shall prioritize awarding grants or
contracts under this section that will serve the following areas:
``(1) Areas with high rates of veterans enrolled in the
family caregiver program.
``(2) Areas with high rates of--
``(A) suicide among veterans; or
``(B) referrals to the Veterans Crisis Line.
``(e) Required Activities.--Any grant or contract awarded under
this section shall be used--
``(1) to expand existing programs, activities, and
services;
``(2) to establish new or additional programs, activities,
and services; or
``(3) for travel and transportation to facilitate carrying
out paragraph (1) or (2).
``(f) Outcome Measures.--(1) The Secretary shall develop and
provide to each entity that receives a grant or contract under this
section written guidance on the following:
``(A) Outcome measures.
``(B) Policies of the Department.
``(2) In developing outcome measures under paragraph (1), the
Secretary shall consider the following goals:
``(A) Increasing the utilization of mental health services
among family caregivers of veterans participating in the family
caregiver program.
``(B) Reducing barriers to mental health services among
family caregivers of veterans participating in such program.
``(g) Tracking Requirements.--(1) The Secretary shall establish
appropriate tracking requirements with respect to the entities
receiving a grant or contract under this section.
``(2) Not less frequently than annually, the Secretary shall submit
to Congress a report on such tracking requirements.
``(h) Performance Review.--The Secretary shall--
``(1) review the performance of each entity that receives a
grant or contract under this section; and
``(2) make information regarding such performance publicly
available.
``(i) Remediation Plan.--(1) In the case of an entity that receives
a grant or contract under this section and does not meet the outcome
measures developed by the Secretary under subsection (g), the Secretary
shall require the entity to submit to the Secretary a remediation plan
under which the entity shall describe how and when it plans to meet
such outcome measures.
``(2) The Secretary may not award a subsequent grant or contract
under this section to an entity described in paragraph (1) unless the
Secretary approves the remediation plan submitted by the entity under
such paragraph.
``(j) Maximum Amount.--The amount of a grant or contract awarded
under this section may not exceed 10 percent of amounts made available
for grants or contracts under this section for the fiscal year in which
the grant or contract is awarded.
``(k) Supplement, Not Supplant.--Any grant or contract awarded
under this section shall be used to supplement and not supplant funding
that is otherwise available through the Department to provide mental
health support among family caregivers of veterans participating in the
family caregiver program.
``(l) Outreach to Family Caregivers.--The Secretary shall include,
in the outreach materials regularly provided to a family caregiver who
participates in the family caregiver program, notice of mental health
support provided by recipients of grants or contracts under this
section that are located in the relevant Veterans Integrated Service
Network.
``(m) Funding.--(1) Amounts for the activities of the Department
under this section shall be budgeted and appropriated through a
separate appropriation account.
``(2) In the budget justification materials submitted to Congress
in support of the budget of the Department for any fiscal year (as
submitted with the budget of the President under section 1105(a) of
title 31), the Secretary shall include a separate statement of the
amount requested to be appropriated for that fiscal year for the
account specified in paragraph (1).
``(n) Authorization of Appropriations.--There is authorized to be
appropriated to the Secretary, for each of fiscal years 2025 and 2026,
$10,000,000 to carry out this section.
``(o) Definitions.--In this section:
``(1) The terms `caregiver' and `family caregiver' have the
meanings given those terms in section 1720G of this title.
``(2) The term `family caregiver program' means the program
of comprehensive assistance for family caregivers under section
1720G of this title.
``(3) The term `Veterans Crisis Line' means the toll-free
hotline for veterans established under section 1720F of this
title.''.
SEC. 123. HOME- AND COMMUNITY-BASED SERVICES: PROGRAMS.
(a) Programs.--Such subchapter is further amended by inserting
after section 1720K (as added by section 122) the following new section
(and conforming the table of sections at the beginning of such chapter
accordingly):
``Sec. 1720L. Home- and community-based services: programs
``(a) In General.--In furnishing noninstitutional alternatives to
nursing home care pursuant to the authority of section 1720C of this
title (or any other authority under this chapter or other provision of
law administered by the Secretary of Veterans Affairs), the Secretary
shall carry out each of the programs specified in this section in
accordance with such relevant authorities except as otherwise provided
in this section.
``(b) Veteran-Directed Care Program.--(1) The Secretary of Veterans
Affairs, in collaboration with the Secretary of Health and Human
Services, shall carry out a program to be known as the `Veteran-
Directed Care program'. Under such program, the Secretary of Veterans
Affairs may enter into agreements with the providers described in
paragraph (2) to provide to eligible veterans funds, to the extent
practicable, to obtain such in-home care services and related items
that support clinical need and improve quality of life, as may be
determined appropriate by the Secretary of Veterans Affairs and
selected by the veteran, including through the veteran hiring
individuals to provide such services and items or directly purchasing
such services and items.
``(2) The providers described in this paragraph are the following:
``(A) An Aging and Disability Resource Center, an area
agency on aging, or a State agency.
``(B) A center for independent living.
``(C) An Indian tribe or tribal organization receiving
assistance under title VI of the Older Americans Act of 1965
(42 U.S.C. 3057 et seq.).
``(D) Any other entity that the Secretary, in consultation
with the Secretary of Health and Human Services, determines
appropriate.
``(3) In carrying out the Veteran-Directed Care program, the
Secretary of Veterans Affairs shall--
``(A) administer such program through each medical center
of the Department of Veterans Affairs;
``(B) seek to ensure the availability of such program in
American Samoa, Guam, the Commonwealth of the Northern Mariana
Islands, the Commonwealth of Puerto Rico, the Virgin Islands of
the United States, and any other territory or possession of the
United States, to the extent practicable; and
``(C) seek to ensure the availability of such program for
eligible veterans who are Native American veterans receiving
care and services furnished by the Indian Health Service, a
tribal health program, an Urban Indian organization, or (in the
case of a Native Hawaiian veteran) a Native Hawaiian health
care system, to the extent practicable.
``(4) If a veteran participating in the Veteran-Directed Care
program is hospitalized, the veteran may continue to use funds under
the program during a period of hospitalization in the same manner that
the veteran would be authorized to use such funds under the program if
the veteran were not hospitalized.
``(c) Homemaker and Home Health Aide Program.--(1) The Secretary
shall carry out a program to be known as the `Homemaker and Home Health
Aide program' under which the Secretary may enter into agreements with
home health agencies to provide to eligible veterans such home health
aide services as may be determined appropriate by the Secretary.
``(2) In carrying out the Homemaker and Home Health Aide program,
the Secretary shall--
``(A) administer such program in the locations specified in
subparagraph (A) of subsection (b)(3);
``(B) seek to ensure the availability of such program in
the locations specified in subparagraph (B) of subsection
(b)(3); and
``(C) seek to ensure the availability of such program for
the veteran populations specified in subparagraph (C) of
subsection (b)(3).
``(d) Home-Based Primary Care Program.--The Secretary shall carry
out a program to be known as the `Home-Based Primary Care program'
under which the Secretary may furnish to eligible veterans in-home
health care, the provision of which is overseen by a provider of the
Department.
``(e) Purchased Skilled Home Care Program.--The Secretary shall
carry out a program to be known as the `Purchased Skilled Home Care
program' under which the Secretary may furnish to eligible veterans
such in-home care services as may be determined appropriate and
selected by the Secretary for the veteran.
``(f) Caregiver Support.--(1) With respect to a resident eligible
caregiver of a veteran participating in a program under this section,
the Secretary shall--
``(A) if the veteran meets the requirements of a covered
veteran under section 1720G(b) of this title, provide to such
caregiver the option of enrolling in the program of general
caregiver support services under such section;
``(B) provide to such caregiver covered respite care of not
less than 30 days annually; and
``(C) conduct on an annual basis (and, to the extent
practicable, in connection with in-person services provided
under the program in which the veteran is participating), a
wellness contact of such caregiver.
``(2) Covered respite care provided to a resident eligible
caregiver of a veteran under paragraph (1) may exceed 30 days annually
if such extension is requested by the resident eligible caregiver or
veteran and determined medically appropriate by the Secretary.
``(g) Rule of Construction.--Nothing in this section shall be
construed to limit the authority of the Secretary to carry out programs
providing home- and community-based services under any other provision
of law.
``(h) Definitions.--In this section:
``(1) The terms `Aging and Disability Resource Center',
`area agency on aging', and `State agency' have the meanings
given those terms in section 102 of the Older Americans Act of
1965 (42 U.S.C. 3002).
``(2) The terms `caregiver' and `family caregiver', with
respect to a veteran, have the meanings given those terms,
respectively, under subsection (e) of section 1720G of this
title with respect to an eligible veteran under subsection (a)
of such section or a covered veteran under subsection (b) of
such section, as the case may be.
``(3) The term `center for independent living' has the
meaning given that term in section 702 of the Rehabilitation
Act of 1973 (29 U.S.C. 796a).
``(4) The term `covered respite care' has the meaning given
such term in section 1720G(d) of this title.
``(5) The term `eligible veteran' means any veteran--
``(A) for whom the Secretary determines
participation in a specific program under this section
is medically necessary to promote, preserve, or restore
the health of the veteran; and
``(B) who absent such participation would be at
increased risk for hospitalization, placement in a
nursing home, or emergency room care.
``(6) The term `home health aide' means an individual
employed by a home health agency to provide in-home care
services.
``(7) The term `in-home care service' means any service,
including a personal care service, provided to enable the
recipient of such service to live at home.
``(8) The terms `Indian tribe' and `tribal organization'
have the meanings given those terms in section 4 of the Indian
Self-Determination and Education Assistance Act (25 U.S.C.
5304).
``(9) The terms `Native American' and `Native American
veteran' have the meanings given those terms in section 3765 of
this title.
``(10) The terms `Native Hawaiian' and `Native Hawaiian
health care system' have the meanings given those terms in
section 12 of the Native Hawaiian Health Care Improvement Act
(42 U.S.C. 11711).
``(11) The terms `tribal health programs' and `Urban Indian
organizations' have the meanings given those terms in section 4
of the Indian Health Care Improvement Act (25 U.S.C. 1603).
``(12) The term `resident eligible caregiver' means an
individual who--
``(A) is a caregiver, or a family caregiver, of a
veteran and resides with that veteran; and
``(B) has not entered into a contract, agreement,
or other arrangement for such individual to act as a
caregiver for that veteran unless such individual is a
family member of the veteran or is furnishing caregiver
services through a medical foster home.''.
(b) Deadline for Improved Administration.--The Secretary of
Veterans Affairs shall ensure that the Veteran-Directed Care program
and the Homemaker and Home Health Aide program are administered through
each medical center of the Department of Veterans Affairs in accordance
with section 1720L of title 38, United States Code (as added by
subsection (a)), by not later than two years after the date of the
enactment of this Act.
(c) Administration of Veteran-Directed Care Program.--
(1) Procedures.--
(A) The Secretary shall establish procedures to--
(i) identify the staffing needs for the
Veteran-Directed Care program of the Department
of Veterans Affairs under such section (as
added by subsection (a)); and
(ii) define the roles and responsibilities
for personnel of the Department responsible for
the administration of such program, including
such personnel employed at the national,
Veterans Integrated Service Network, or medical
facility level.
(B) The responsibilities described in clause (ii)
of subparagraph (A) shall include responsibilities for
engagement with--
(i) veterans participating in such program;
(ii) veterans interested in participating
in such program; and
(iii) providers described in section
1720L(b)(2) (as added by subsection (a)).
(2) Staffing model; report.--Not later than two years after
enactment of this Act, the Secretary of Veterans Affairs
shall--
(A) establish a staffing model for the
administration of such program at each medical facility
of the Department of Veterans Affairs; and
(B) submit to the Committees on Veterans' Affairs
of the House of Representatives and the Senate a report
containing the following:
(i) A description of--
(I) the staffing model described in
subparagraph (A); and
(II) the rationale for such
staffing model.
(ii) An identification of the ratio of
staff required to administer such program to
the number of veterans served by such program,
disaggregated by each medical facility of the
Department of Veterans Affairs.
(iii) A description of budgetary resources
or other support, if any, required to
accommodate an increase in staffing at medical
facilities of the Department of Veterans
Affairs pursuant to the requirements of the
staffing model described in subparagraph (A).
(iv) Such other matters as the Secretary of
Veterans Affairs determines appropriate.
SEC. 124. COORDINATION WITH ASSISTANCE AND SUPPORT SERVICES FOR
CAREGIVERS.
(a) Coordination With Program of Comprehensive Assistance for
Family Caregivers.--
(1) Coordination.--Section 1720G(a) of title 38, United
States Code, is amended by adding at the end the following new
paragraph:
``(14)(A) In the case of a veteran or caregiver who seeks services
under this subsection and is denied such services, or a veteran or the
family caregiver of a veteran who is discharged from the program under
this subsection, the Secretary shall--
``(i) if the veteran meets the requirements of a covered
veteran under subsection (b), provide to such caregiver the
option of enrolling in the program of general caregiver support
services under such subsection;
``(ii) assess the veteran or caregiver for participation in
any other available program of the Department for home- and
community-based services (including the programs specified in
section 1720L of this title) for which the veteran or caregiver
may be eligible and, with respect to the veteran, store (and
make accessible to the veteran) the results of such assessment
in the electronic medical record of the veteran; and
``(iii) provide to the veteran or caregiver written
information on any such program identified pursuant to the
assessment under clause (ii), including information about
facilities, eligibility requirements, and relevant contact
information for each such program.
``(B) The Secretary shall, to the extent practicable, provide to a
veteran or family caregiver the option of obtaining clinically
appropriate services under any other available program of the
Department for home- and community-based services (including the
programs specified in section 1720L of this title) for which the
veteran or family caregiver may be eligible prior to discharging the
veteran or family caregiver from the program under this subsection.
``(C) For each veteran or family caregiver who is discharged from
the program under this subsection, a caregiver support coordinator
shall provide for a smooth and personalized transition from such
program to an appropriate program of the Department for home- and
community-based services (including the programs specified in section
1720L of this title), including by integrating caregiver support across
programs.''.
(2) Applicability.--The amendments made by paragraph (1)
shall apply with respect to denials and discharges occurring on
or after the date that is 180 days after the date of the
enactment of this Act.
(3) Technical and conforming amendments.--Section 1720G(d)
of such title is amended--
(A) by striking ``or a covered veteran'' each place
it appears and inserting ``, a veteran denied or
discharged as specified in paragraph (14) of such
subsection, or a covered veteran''; and
(B) by striking ``under subsection (a), means''
each place it appears and inserting ``under subsection
(a) or a veteran denied or discharged as specified in
paragraph (14) of such subsection, means''.
(b) Conformity of Respite Care Across Programs.--Section 1720G of
title 38, United States Code, as amended by subsection (a)(3), is
further amended--
(1) in subsection (a)(3)--
(A) by amending subparagraph (A)(ii)(III) to read
as follows:
``(III) covered respite care of not less than 30
days annually;''; and
(B) by striking subparagraph (B) and redesignating
subparagraphs (C) and (D) as subparagraphs (B) through
(C), respectively; and
(2) by amending subsection (b)(3)(A)(iii) to read as
follows:
``(iii) Covered respite care of not less than 30 days
annually.''; and
(3) in subsection (d)--
(A) by redesignating paragraphs (2) through (4) as
paragraphs (3) through (5), respectively; and
(B) by inserting after paragraph (1) the following
new paragraph:
``(2) The term `covered respite care' means, with respect
to a caregiver of a veteran, respite care under section 1720B
of this title that--
``(A) is medically and age appropriate for the
veteran (including 24-hour per day care of the veteran
commensurate with the care provided by the caregiver);
and
``(B) includes in-home care.''.
(c) Review Relating to Caregiver Contact.--The Secretary shall
conduct a review of the capacity of the Department to establish a
streamlined system for contacting all caregivers enrolled in the
program of general caregiver support services under section 1720G(b) of
title 38, United States Code, to provide to such caregivers program
updates and alerts relating to emerging services for which such
caregivers or the veterans for which they provide care may be eligible.
SEC. 125. IMPROVEMENTS TO PROGRAM OF COMPREHENSIVE ASSISTANCE FOR
FAMILY CAREGIVERS.
Section 1720G(a) of title 38, United States Code, as amended by
section 124, is further amended--
(1) in paragraph (12)--
(A) in subparagraph (A), by inserting ``, which
shall include all criteria used to determine
eligibility for such assistance and, in the case of a
completed evaluation, how such criteria were used to
evaluate information provided in assessments to
determine such eligibility'' before the period at the
end; and
(B) in subparagraph (C)(i), by striking ``who
submits'' and all that follows through the end of the
clause and inserting the following: ``who--
``(I) submits an application for the program
established under paragraph (1); or
``(II) is being reassessed for eligibility to
continue in such program.''; and
(2) by adding at the end the following new paragraph:
``(15)(A) Not less frequently than annually, the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and the
House of Representatives a comprehensive report on the program required
by paragraph (1) that includes, with respect to one-year period
preceding the date of the submission of such report, the following:
``(i) The number of applications received for such program.
``(ii) The number, disaggregated by race, sex, and era and
branch of service in the Armed Forces of the applicant, of--
``(I) approvals of such applications; and
``(II) denials of such applications.
``(iii) The number of reassessments conducted for such
program.
``(iv) An identification of each decision made with respect
to a reassessment conducted for such program, disaggregated by
decisions resulting in--
``(I) disenrollment, including removal, discharge,
or voluntary withdrawal;
``(II) tier reduction; and
``(III) tier continuation.
``(v) The number of appeals of decisions made with respect
to such program, disaggregated by type of appeal.
``(vi) With respect to each appeal described in clause (v),
the decision rendered, if any.
``(vii) A description of all tools used in assessments
conducted for such program, including an explanation of how and
by whom such tools are administered.
``(viii) A description of procedures used under such
program for reviewing and integrating clinical records from
health care providers that includes an explanation of how such
records are used in determinations of eligibility for such
program.
``(ix) A description of procedures available under such
program for health care providers to communicate medical
opinions to the teams conducting assessments to determine
eligibility for such program, including health care providers
in the private sector and health care providers specified in
subsection (c) of section 1703 of this title.
``(x) A description of information technology systems and
processes used under such program to upload and integrate all
clinical records from all non-Department providers, including
providers in the private sector and providers under the
Veterans Community Care Program established under such section.
``(B) The Secretary shall ensure that all data included in a report
under subparagraph (A)--
``(i) relating to a decision made under the program
required by paragraph (1), are disaggregated by the specific
reason for the decision;
``(ii) relating to a veteran, include comprehensive
demographic information of the veteran, including the time
period of the injuries, if any, of the veteran and the Veterans
Integrated Service Network in which the veteran is located; and
``(iii) with respect to eligibility determinations relating
to a serious injury of a veteran, specify--
``(I) how many such determinations relate to the
ability of the veteran to perform activities of daily
living; and
``(II) how many such determinations relate to the
need of a veteran for supervision and protection.
``(C) The Secretary shall provide the data under paragraph (B)
pursuant to Federal laws and in a manner that is wholly consistent with
applicable Federal privacy and confidentiality laws, including but the
Privacy Act (5 U.S.C. 552a), the Health Insurance Portability and
Accountability Act (Public Law 104-191; 42 U.S.C. 201 note) and
regulations (title 45, Code of Federal Regulations, parts 160 and 164,
or successor regulations), and sections 5701, 5705, and 7332 of this
title to ensure that the provided data, or some portion of the data,
will not undermine the anonymity of a veteran.''.
SEC. 126. IMPROVEMENTS RELATING TO HOMEMAKER AND HOME HEALTH AIDE
PROGRAM.
(a) Pilot Program for Communities With Shortage of Home Health
Aides.--
(1) Program.--Beginning not later than 18 months after the
date of the enactment of this Act, the Secretary shall carry
out a three-year pilot program under which the Secretary shall
provide homemaker and home health aide services to veterans who
reside in communities with a shortage of home health aides.
(2) Locations.--The Secretary shall select not fewer than
five geographic locations in which the Secretary determines
there is a shortage of home health aides at which to carry out
the pilot program under paragraph (1).
(3) Nursing assistants.--
(A) In general.--In carrying out the pilot program
under paragraph (1), the Secretary may hire nursing
assistants as new employees of the Department of
Veterans Affairs, or reassign nursing assistants who
are existing employees of the Department, to provide to
veterans in-home care services (including basic tasks
authorized by the State certification of the nursing
assistant) under the pilot program, in lieu of or in
addition to the provision of such services through non-
Department home health aides.
(B) Relationship to home-based primary care
program.--Nursing assistants hired or reassigned under
subparagraph (A) may provide services to a veteran
under the pilot program under paragraph (1) while
serving as part of a health care team for the veteran
under the Home-Based Primary Care program.
(4) Report to congress.--Not later than one year before the
date of the termination of the pilot program under paragraph
(1), the Secretary shall submit to the Committees on Veterans'
Affairs of the House of Representatives and the Senate a report
that includes--
(A) a statement of the results of such pilot
program; and
(B) an assessment of the feasibility and
advisability of--
(i) extending such pilot program; or
(ii) making such pilot program a permanent
program of the Department of Veterans Affairs.
(b) Report on Use of Funds.--Not later than one year after the date
of the enactment of this Act, the Secretary of Veterans Affairs shall
submit to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report containing, with respect to the
period beginning in fiscal year 2012 and ending in fiscal year 2023,
the following:
(1) An identification of the amount of funds that were
included in a budget of the Department of Veterans Affairs
during such period for the provision of in-home care to
veterans under the Homemaker and Home Health Aide program but
were not expended for such provision, disaggregated by medical
center of the Department for which such unexpended funds were
budgeted (if such disaggregation is possible).
(2) To the extent practicable, an identification of the
number of veterans for whom, during such period, the hours
during which a home health aide was authorized to provide
services to the veteran under the Homemaker and Home Health
Aide program were reduced for a reason other than a change in
the health care needs of the veteran, and a detailed
description of the reasons why any such reductions may have
occurred.
(c) Updated Guidance on Program.--Not later than one year after the
date of the enactment of this Act, the Secretary shall issue updated
guidance for the Homemaker and Home Health Aide program. Such updated
guidance shall include the following:
(1) A process for the transition of veterans from the
Homemaker and Home Health Aide program to other covered
programs.
(2) A requirement for the directors of the medical
facilities of the Department to complete such process whenever
a veteran with care needs has been denied services from home
health agencies under the Homemaker and Home Health Aide
program as a result of the clinical needs or behavioral issues
of the veteran.
SEC. 127. PILOT PROGRAM TO FURNISH ASSISTED LIVING SERVICES TO CERTAIN
VETERANS.
(a) Establishment.--Beginning not later than two years after the
date of the enactment of this Act, the Secretary of Veterans Affairs
shall carry out a pilot program to assess--
(1) the effectiveness of providing assisted living services
to eligible veterans, at the election of such veterans; and
(2) the satisfaction with the pilot program of veterans
participating in such pilot program.
(b) Program Locations.--
(1) Veterans integrated service networks.--The Secretary
shall select two Veterans Integrated Service Networks of the
Department of Veterans Affairs at which to carry out the pilot
program under subsection (a).
(2) Facilities.--
(A) In general.--Within the Veterans Integrated
Service Networks selected under paragraph (1), the
Secretary shall select facilities at which to carry out
the pilot program under subsection (a)(1).
(B) Selection criteria.--In selecting facilities
under subparagraph (A) at which to carry out the pilot
program under subsection (a)(1), the Secretary shall
ensure that--
(i) the locations of such facilities are in
geographically diverse areas;
(ii) not fewer than one such facility
serves veterans in rural or highly rural areas
(as determined through the use of the Rural-
Urban Commuting Areas coding system of the
Department of Agriculture);
(iii) not fewer than one such facility is
located in each Veterans Integrated Service
Network selected under paragraph (1); and
(iv) not fewer than one such facility is a
State home.
(c) Program Participants.--Not more than 60 eligible veterans may
participate in the pilot program under subsection (a)(1) in each
Veterans Integrated Service Network selected under subsection (b)(1).
(d) Provision of Assisted Living Services.--
(1) Agreements.--In carrying out the pilot program under
subsection (a)(1), the Secretary may enter into agreements for
the provision of assisted living services on behalf of eligible
veterans with--
(A) a provider participating under a State plan or
waiver under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.); or
(B) a State home recognized and certified under
subpart B of part 51 of title 38, Code of Federal
Regulations, or successor regulations.
(2) Standards.--The Secretary may not place, transfer, or
admit a veteran to any facility for assisted living services
under the pilot program under subsection (a)(1) unless the
Secretary determines that--
(A) the facility meets the standards for community
residential care established under sections 17.61
through 17.72 of title 38, Code of Federal Regulations,
or successor regulations, and any additional standards
of care as the Secretary may specify; or
(B) in the case of a facility that is a State home,
the State home meets such standards of care as the
Secretary may specify.
(3) Inspection.--The Secretary shall inspect facilities at
which veterans are placed under the pilot program under
subsection (a)(1)--
(A) with respect to a facility that is a State
home, not less frequently than annually and in the same
manner as the Secretary conducts inspection of State
homes under section 1742 of title 38, United States
Code; and
(B) with respect to any other facility, not less
frequently than annually and in the same manner as the
Secretary conducts inspection of facilities under
section 1730 of such title.
(4) Payment to certain facilities.--
(A) State homes.--In the case of a facility
participating in the pilot program under subsection
(a)(1) that is a State home, the Secretary shall pay to
the State home a per diem for each veteran
participating in the pilot program at a rate agreed to
by the Secretary and the State home.
(B) Community assisted living facilities.--In the
case of a facility participating in the pilot program
under subsection (a)(1) that is a community assisted
living facility, the Secretary shall--
(i) pay to the facility an amount that is
less than the average rate paid by the
Department for placement in a community nursing
home in the same Veterans Integrated Service
Network; and
(ii) re-evaluate payment rates annually to
account for current economic conditions and
current costs of assisted living services.
(e) Continuity of Care.--Upon the termination of the pilot program
under subsection (a)(1), the Secretary shall--
(1) provide to all veterans participating in the pilot
program at the time of such termination the option to continue
to receive assisted living services at the site they were
assigned to under the pilot program, at the expense of the
Department; and
(2) for such veterans who do not opt to continue to receive
such services--
(A) ensure such veterans do not experience lapses
in care; and
(B) provide such veterans with information on, and
furnish such veterans with, other extended care
services based on their preferences and best medical
interest.
(f) Determination of Quality.--The Secretary shall determine a
method for assessment of quality of care provided to veterans
participating in the pilot program under subsection (a)(1) and shall
communicate that method to providers of services under the pilot
program.
(g) Annual Report.--Not later than one year after the initiation of
the pilot program under subsection (a)(1), and annually thereafter for
the duration of such pilot program, the Secretary shall submit to the
Committees on Veterans' Affairs of the House of Representatives and the
Senate a report on the pilot program that includes--
(1) an identification of Veterans Integrated Services
Networks and facilities of the Department participating in the
pilot program and assisted living facilities and State homes at
which veterans are placed under the pilot program;
(2) the number of participants in the pilot program,
disaggregated by facility;
(3) general demographic information of participants in the
pilot program, including average age, sex, and race or
ethnicity;
(4) disability status of participants in the pilot program;
(5) an identification of any barriers or challenges to
furnishing care to veterans under the pilot program, conducting
oversight of the pilot program, or any other barriers or
challenges;
(6) the cost of care at each assisted living facility and
State home participating in the pilot program, including an
analysis of any cost savings by the Department when comparing
that cost to the cost of nursing home care;
(7) aggregated feedback from participants in the pilot
program, including from veteran resident surveys and
interviews; and
(8) such other matters the Secretary considers appropriate.
(h) Final Report.--Not later than one year after the pilot program
terminates under subsection (j), the Secretary shall submit to the
Committees on Veterans' Affairs of the House of Representatives and the
Senate a report on the pilot program that--
(1) includes the matters required under paragraphs (1)
through (8) of subsection (g);
(2) includes recommendations on whether the model studied
in the pilot program should be continued or adopted throughout
the Department; and
(3) indicates whether the Secretary requests action by
Congress to make the pilot program permanent.
(i) Inspector General Report.--
(1) In general.--Not later than three years after the
initiation of the pilot program under subsection (a)(1), the
Inspector General of the Department of Veterans Affairs shall
submit to the Secretary of Veterans Affairs and the Committees
on Veterans' Affairs of the House of Representatives and the
Senate a report on the pilot program.
(2) Elements.--The report required by paragraph (1) shall
include an assessment of--
(A) the quality of care provided to veterans at
facilities participating in the pilot program, measured
pursuant to the method determined under subsection (f);
(B) the oversight of such facilities, as conducted
by the Department, the Centers for Medicare & Medicaid
Services, State agencies, and other relevant entities;
and
(C) such other matters as the Inspector General
considers appropriate.
(3) Plan required.--Not later than 90 days after the
submission of the report under paragraph (1), the Secretary
shall submit to the Committees on Veterans' Affairs of the
House of Representatives and the Senate a plan to address the
deficiencies identified in the report, if any.
(j) Termination.--
(1) In general.--Subject to paragraph (2), the pilot
program under subsection (a)(1) shall terminate on September
30, 2026.
(2) Extension.--The Secretary may extend the duration of
the pilot program for an additional two-year period if the
Secretary, based on the results of the reports submitted under
subsection (g), determines such an extension is appropriate.
(k) Definitions.--In this section:
(1) The term ``assisted living services'' means services of
a facility in providing room, board, and personal care for and
supervision of residents for their health, safety, and welfare.
(2) The term ``eligible veteran'' means a veteran who is--
(A) receiving nursing home care paid for by the
Department of Veterans Affairs, eligible to receive
such care pursuant to section 1710A of title 38, United
States Code, or requires a higher level of care than
the domiciliary care provided by the Department of
Veterans Affairs, but does not meet the requirements
for nursing home level care provided by the Department
pursuant to such section; and
(B) eligible for assisted living services, as
determined by the Secretary or meets such additional
criteria for eligibility for the pilot program under
subsection (a)(1) as the Secretary may establish.
(3) The term ``State home'' has the meaning given that term
in section 101 of title 38, United States Code.
SEC. 128. PROVISION OF MEDICINE, EQUIPMENT, AND SUPPLIES AVAILABLE TO
DEPARTMENT OF VETERANS AFFAIRS TO STATE HOMES.
(a) Provision Authorized.--The Secretary of Veterans Affairs may
provide to State homes medicine, personal protective equipment, medical
supplies, and any other equipment, supplies, and assistance available
to the Department of Veterans Affairs.
(b) Definition.--In this section:
(1) The term ``personal protective equipment'' means any
protective equipment required to prevent the wearer from
contracting an infectious disease, including gloves, N-95
respirator masks, gowns, goggles, face shields, or other
equipment required for safety.
(2) The term ``State home'' has the meaning given such term
in section 101 of title 38, United States Code.
SEC. 129. RECOGNITION OF ORGANIZATIONS AND INDIVIDUALS TO ASSIST
VETERANS, FAMILY MEMBERS, AND CAREGIVERS NAVIGATING
PROGRAMS AND SERVICES OF VETERANS HEALTH ADMINISTRATION.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
establish a process through which the Department of Veterans Affairs
may recognize organizations and individuals to assist a veteran, a
family member of a veteran, or a caregiver of a veteran (as defined in
section 1720G(d) of title 38, United States Code) in navigating the
programs and services of the Veterans Health Administration.
(b) Solicitation of Feedback.--The Secretary shall solicit feedback
and recommendations in the creation of the process under subsection (a)
from such organizations as the Secretary may consider relevant.
(c) Limitation.--The Secretary may not recognize an organization or
individual pursuant to the process established under subsection (a)
unless the organization or individual has certified to the Secretary
that no fee or compensation of any nature will be charged to any
individual for services rendered in providing assistance pursuant to
such subsection.
SEC. 130. REVIEWS AND OTHER IMPROVEMENTS RELATING TO HOME- AND
COMMUNITY-BASED SERVICES.
(a) Office of Geriatric and Extended Care.--
(1) Review of programs.--The Under Secretary for Health of
the Department of Veterans Affairs shall conduct a review of
each program administered through the Office of Geriatric and
Extended Care of the Department and the Caregiver Support
Program Office of the Department, or any successor offices,
to--
(A) eliminate service gaps at the medical center
level; and
(B) ensure--
(i) the clinical needs of veterans are met;
(ii) consistency in program management;
(iii) the availability of, and the access
by veterans to, home- and community-based
services, including for veterans living in
rural areas; and
(iv) proper coordination between covered
programs.
(2) Assessment of staffing needs.--The Secretary of
Veterans Affairs shall conduct an assessment of the staffing
needs of the Office of Geriatric and Extended Care of the
Department and the Caregiver Support Program Office of the
Department, or any successor offices.
(3) Goals for geographic alignment of care.--
(A) Establishment of goals.--The Director of the
Office of Geriatric and Extended Care, or successor
office, shall establish quantitative goals to enable
aging or disabled veterans who are not located near
medical centers of the Department to access extended
care services (including by improving access to home-
and community-based services for such veterans).
(B) Implementation timeline.--Each goal established
under subparagraph (A) shall include a timeline for the
implementation of the goal at each medical center of
the Department.
(4) Goals for in-home specialty care.--The Director of the
Office of Geriatric and Extended Care, or successor office,
shall establish quantitative goals to address the specialty
care needs of veterans through in-home care, including by
ensuring the education of home health aides and caregivers of
veterans in the following areas:
(A) Dementia care.
(B) Care for spinal cord injuries and diseases.
(C) Ventilator care.
(D) Other speciality care areas as determined by
the Secretary.
(5) Input on goals.--To the extent practicable, the head of
the Caregiver Support Program Office, or successor office,
shall provide to the Director of the Office of Geriatric and
Extended Care, or successor office, input with respect to the
establishment of the goals under paragraphs (3) and (4).
(6) Report to congress.--Not later than one year after the
date of the enactment of this Act, the Secretary shall submit
to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report containing the findings
of the review under paragraph (1), the results of the
assessment under paragraph (2), and the goals established under
paragraphs (3) and (4).
(b) Review of Incentives and Efforts Relating to Home- and
Community-Based Services.--
(1) Review.--The Secretary of Veterans Affairs shall
conduct a review of the following:
(A) The financial and organizational incentives or
disincentives for the directors of medical centers of
the Department to establish or expand covered programs
at such medical centers.
(B) Any incentives or disincentives for such
directors to provide to veterans home- and community-
based services in lieu of institutional care.
(C) The efforts taken by the Secretary to enhance
spending of the Department for extended care by
balancing spending between institutional care and home-
and community-based services consistent with the demand
for such services.
(D) The plan of the Under Secretary for Health of
the Department to accelerate efforts to enhance
spending as specified in subparagraph (C), to match the
progress of similar efforts taken by the Administrator
of the Centers for Medicare & Medicaid Services with
respect to spending of the Centers for Medicare &
Medicaid Services for extended care.
(2) Report to congress.--Not later than one year after the
date of the enactment of this Act, the Secretary shall submit
to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report on the findings of the
review under paragraph (1).
(c) Review of Respite Care Services.--Not later than two years
after the date of the enactment of this Act, the Secretary of Veterans
Affairs shall conduct a review of the use, availability, cost, and
effectiveness, of the respite care services furnished by the Secretary
under chapter 17 of title 38, United States Code, including--
(1) the frequency at which the Department of Veterans
Affairs is unable to meet demand for such services;
(2) a detailed description of--
(A) the reasons the Department of Veterans Affairs
is unable to meet the demand for such services; and
(B) any actions, or planned actions, of the
Secretary of Veterans Affairs to ensure such demand is
met.
(d) Collaboration To Improve Home- and Community-based Services.--
(1) Recommendations.--
(A) Development.--The Secretary of Veterans Affairs
shall develop recommendations as follows:
(i) With respect to home- and community-
based services for veterans, the Secretary of
Veterans Affairs shall develop recommendations
regarding new services (in addition to those
furnished as of the date of enactment of this
Act) in collaboration with the Secretary of
Health and Human Services.
(ii) With respect to the national shortage
of home health aides, the Secretary of Veterans
Affairs shall develop recommendations regarding
methods to address such shortage in
collaboration with the Secretary of Health and
Human Services and the Secretary of Labor.
(B) Submission to congress.--The Secretary of
Veterans Affairs shall submit to the Committees on
Veterans' Affairs of the House of Representatives and
the Senate a report containing the recommendations
developed under subparagraph (A) and an identification
of any changes in existing law or new statutory
authority necessary to implement the recommendations,
as determined by the Secretary.
(C) Consultation with secretary of labor.--In
carrying out this paragraph, the Secretary of Veterans
Affairs shall consult with the Secretary of Labor.
(2) Feedback and recommendations on caregiver support.--
(A) Feedback and recommendations.--The Secretary of
Veterans Affairs shall solicit from the entities
described in subparagraph (B) feedback and
recommendations regarding opportunities for the
Secretary to enhance home- and community-based services
for veterans and the caregivers of veterans, including
through the potential provision by the entity of care
and respite services to veterans and caregivers who may
not be eligible for any program under section 1720G of
title 38, United States Code, or section 1720L of such
title (as added by section 124), but have a need for
assistance.
(B) Covered entities.--The entities described in
this subparagraph are veterans service organizations
and nonprofit organizations with a focus on caregiver
support or long term care (as determined by the
Secretary).
(3) Collaboration for certain veterans.--The Secretary of
Veterans Affairs shall collaborate with the Director of the
Indian Health Service and representatives from tribal health
programs and Urban Indian organizations to ensure the
availability of home- and community-based services for--
(A) Native American veterans, including Native
American veterans receiving health care and medical
services under multiple health care systems; and
(B) Native Hawaiian veterans, including Native
Hawaiian veterans receiving health care and medical
services under the Native Hawaiian health care system.
SEC. 131. GAO REPORT ON MENTAL HEALTH SUPPORT FOR CAREGIVERS.
(a) Report Required.--Not later than one year after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of Representatives a
report on the provision of mental health support to caregivers of
veterans.
(b) Contents.--The report submitted under subsection (a) shall
include the following:
(1) An assessment of the need for mental health support
among caregivers participating in the caregiver programs.
(2) An assessment of options for mental health support in
facilities of the Department of Veterans Affairs and in the
community for caregivers participating in the caregiver
programs.
(3) An assessment of the availability and accessibility of
mental health support in facilities of the Department and in
the community for caregivers participating in the caregiver
programs.
(4) An assessment of the awareness among caregivers of the
availability of mental health support in facilities of the
Department and in the community for caregivers participating in
the caregiver programs.
(5) An assessment of barriers to mental health support in
facilities of the Department and in the community for
caregivers participating in the caregiver programs.
(c) Definitions.--In this section:
(1) The term ``caregiver'' has the meaning given that term
in section 1720G of title 38, United States Code.
(2) The term ``caregiver programs'' means--
(A) the program of comprehensive assistance for
family caregivers under subsection (a) of section 1720G
of title 38, United States Code; and
(B) the program of support services for caregivers
under subsection (b) of such section.
SEC. 132. DEVELOPMENT OF CENTRALIZED WEBSITE FOR PROGRAM INFORMATION.
(a) Centralized Website.--The Secretary shall develop and maintain
a centralized and publicaly accessible internet website of the
Department as a clearinghouse for information and resources relating to
covered programs.
(b) Contents.--The website under subsection (a) shall contain the
following:
(1) A description of each covered program.
(2) An informational assessment tool that--
(A) explains the administrative eligibility, if
applicable, of a veteran, or a caregiver of a veteran,
for any covered program; and
(B) provides information, as a result of such
explanation, on any covered program for which the
veteran or caregiver (as the case may be) may be
eligible.
(3) A list of required procedures for the directors of the
medical facilities of the Department to follow in determining
the eligibility and suitability of veterans for participation
in a covered program, including procedures applicable to
instances in which the resource constraints of a facility (or
of a community in which a facility is located) may result in
the inability to address the health needs of a veteran under a
covered program in a timely manner.
(c) Updates.--The Secretary shall ensure the website under
subsection (a) is updated on a periodic basis.
SEC. 133. DEFINITIONS.
In this title:
(1) The terms ``caregiver'' and ``family caregiver'' have
the meanings given those terms under section 1720L(h) of title
38, United States Code (as added by section 123).
(2) The term ``covered program''--
(A) means any program of the Department of Veterans
Affairs for home- and community-based services; and
(B) includes the programs specified in section
1720L of title 38, United States Code (as added by
section 123).
(3) The term ``home- and community-based services''--
(A) means the services referred to in section
1701(6)(E) of title 38, United States Code; and
(B) includes services furnished under a program
specified in section 1720L of such title (as added by
section 123).
(4) The terms ``Home-Based Primary Care program'',
``Homemaker and Home Health Aide program'', and ``Veteran-
Directed Care program'' mean the programs of the Department of
Veterans Affairs specified in subsection (d), (c), and (b) of
such section 1720L, respectively.
(5) The terms ``home health aide'', ``Native American'',
``Native American veteran'', ``tribal health programs'', and
``Urban Indian organizations'' have the meanings given those
terms in subsection (h) of such section 1720L.
(6) The term ``Vet Center'' has the meaning given that term
in section 1712A(h) of title 38, United States Code.
(7) The term ``veterans service organization'' means any
organization recognized by the Secretary under section 5902 of
such title.
Subtitle C--Medical Treatment and Other Matters
SEC. 140. QUARTERLY REPORT ON REFERRALS FOR NON-DEPARTMENT OF VETERANS
AFFAIRS HEALTH CARE.
Subchapter I of chapter 5 of title 38, United States Code, is
amended by adding at the end the following new section (and amending
the table of sections at the beginning of such chapter accordingly):
``Sec. 534. Quarterly report on referrals for non-Department health
care
``Not later than 180 days after the date of the enactment of this
section, and not less frequently than quarterly thereafter, the
Secretary shall submit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives a report containing, with
respect to referrals for non-Department health care originating from a
medical facility of the Department during the quarter preceding the
date of the submission of the report, a measurement of, for each such
medical facility--
``(1) the period of time between--
``(A) the date on which a clinician employed by the
Department determines that a veteran requires care, or
a veteran presents to the Department requesting care,
and the date on which the referral for care is sent to
a non-Department health care provider;
``(B) the date on which such referral is sent to a
non-Department health care provider and the date on
which such non-Department health care provider accepts
such referral;
``(C) the date on which such non-Department health
care provider accepts such referral and the date on
which such referral is completed;
``(D) the date on which such referral is completed
and the date on which an appointment with a non-
Department health care provider is made; and
``(E) the date on which such an appointment is made
and the date on which such appointment occurs; and
``(2) any other period of time that the Secretary
determines necessary.''.
SEC. 141. ELIMINATION OF CERTAIN REQUIREMENTS FOR CERTAIN DEPARTMENT OF
VETERANS AFFAIRS ASSISTANT UNDER SECRETARIES.
Section 7306 of title 38, United States Code, is amended--
(1) by striking subsection (b);
(2) by redesignating subsections (c) through (g) as
subsections (b) through (f), respectively; and
(3) in subsection (c) (as so redesignated), by striking
``subsection (e)'' and inserting ``subsection (f)''.
SEC. 142. MODIFICATION OF PAY LIMITATION FOR PHYSICIANS, PODIATRISTS,
OPTOMETRISTS, AND DENTISTS OF DEPARTMENT OF VETERANS
AFFAIRS.
(a) Pay.--
(1) In general.--Section 7431 of title 38, United States
Code, is amended--
(A) by inserting ``optometrists,'' after
``podiatrists,'' each place it appears;
(B) by inserting ``optometrist'' after
``podiatrist,'' each place it appears;
(C) in subsection (c)--
(i) in paragraph (5), by adding at the end
the following new sentence: ``Such a notice
shall include a statement of whether the market
pay will increase, decrease, or remain
unchanged following such evaluation.''; and
(ii) by adding at the end the following new
paragraphs:
``(7) The Secretary shall ensure that each physician,
podiatrist, optometrist, and dentist in the Veterans Health
Administration is--
``(A) advised, on an annual basis, of the criteria
described in subparagraph (F) of paragraph (4);
``(B) evaluated in accordance with such criteria;
and
``(C) compensated in accordance with--
``(i) applicable assignment and pay levels,
subject to relevant pay limitations; and
``(ii) the extent to which such criteria is
met.
``(8) Not later than 120 days after the end of each fiscal
year, the Secretary shall submit to the Committees on Veterans'
Affairs of the Senate and the House of Representatives a report
that includes the following:
``(A) A list of each facility and specialty that
conducted an evaluation of pay during the period
covered by the report.
``(B) For each evaluation described in subparagraph
(A)--
``(i) a list of occupations for which pay
was evaluated, disaggregated by medical
specialty, number of authorized full-time
employees, and onsite full-time employees as of
the date of the evaluation;
``(ii) the date such evaluation was
completed;
``(iii) whether a market pay adjustment was
made following the evaluation per each
occupation and specialty evaluated;
``(iv) whether applicable employees were
notified of such evaluation;
``(v) whether local labor partners were
notified of such evaluation; and
``(vi) in the case of an evaluation that
resulted in an adjustment of pay--
``(I) the date such adjustment--
``(aa) was implemented; and
``(bb) became effective;
and
``(II) the percentage of employees
of each occupation and specialty for
which pay was adjusted pursuant to such
evaluation.
``(C) A list of facilities of the Department that
have not conducted an evaluation of market pay,
pursuant to paragraph (5), during the 18-month period
that precedes the date of the submission of such
report.'';
(D) in subsection (e)--
(i) in paragraph (1)(A), by inserting
``optometrists,'' after ``podiatrists,''; and
(ii) by adding at the end the following new
paragraphs:
``(5) Notwithstanding any compensation or pay limitations
under this title or title 5, the Secretary may authorize the
Under Secretary for Health to pay physicians, podiatrists,
optometrists and dentists--
``(A) awards authorized under this title;
``(B) advance payments, recruitment or relocation
bonuses, and retention allowances authorized under
section 7410(a) of this title or as otherwise provided
by law;
``(C) incentives or bonuses under section 706 of
this title or as otherwise provided by law; and
``(D) earnings from fee-basis appointments under
section 7405(a)(2) of this title.
``(6)(A) The Secretary may waive any pay limitation
described in this section (including tier limitations) that the
Secretary determines necessary for the recruitment or retention
of critical health care personnel whom the Secretary determines
would provide direct patient care.
``(B) Priority for such waivers shall be given for
positions, locations, and care provided through contracts at a
high cost to the Department.
``(C) The Chief Human Capital Officer of the Department,
the Chief Financial Officer of the Department, and the Office
of the General Counsel of the Department shall review any
waiver issued under subparagraph (A).
``(D) During the period the authority under subparagraph
(A) is effective, the Secretary may not issue more than 300
waivers under such subparagraph.
``(E) The Secretary may prescribe requirements,
limitations, and other considerations for waivers under such
subparagraph.
``(F) Not later than 180 days after the date of the
enactment of the Senator Elizabeth Dole 21st Century Veterans
Healthcare and Benefits Improvement Act, and annually
thereafter, the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and the House of
Representatives a report that includes--
``(i) any updates to the requirements, limitations,
and considerations prescribed under subparagraph (B)
during the period covered by the report;
``(ii) a description of the findings of each
review, if any, conducted pursuant to subparagraph (C);
``(iii) a description of each waiver under
subparagraph (A) in effect as of the date of the
submission of the report, including the--
``(I) duty location, position, specialty,
market and performance considerations for the
waiver; and
``(II) impact, if any, of the waiver on
contracted care purchased by the Department for
the region; and
``(iv) a list of any separation actions during the
period covered by the report with respect to a position
for which a waiver under subparagraph (A) is in effect.
``(G) The authority of the Secretary under subparagraph (A)
shall terminate on the last day of the third full fiscal year
following the date of the enactment of the Senator Elizabeth
Dole 21st Century Veterans Healthcare and Benefits Improvement
Act.''.
(2) Report on waiver authority.--Not later than 180 days
after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall submit to the Committees on Veterans'
Affairs of the Senate and the House of Representatives a report
that includes a description of the requirements, limitations,
and other considerations prescribed under section 7431(b)(6)(D)
of title 38, United States Code, as added by paragraph (1).
(3) Conforming amendments.--
(A) Pay of under secretary for health.--Section
7432(b)(1) of such title is amended by inserting ``,
podiatrist, optometrist,'' after ``physician''.
(B) Administrative matters.--Section 7433 of such
title is amended by inserting ``optometrists,'' after
``physicians,'' each place it appears.
(C) Competitive pay.--Section 7451(a)(2)(C) of such
title is amended by inserting ``optometrist,'' after
``physician,''.
(4) Clerical amendments.--
(A) Subchapter heading.--Subchapter III of chapter
74 of such title is amended in the heading by inserting
``Optometrists,'' after ``PODIATRISTS,''.
(B) Table of sections.--The table of sections for
such chapter is amended by striking the item relating
to subchapter III and inserting the following:
``subchapter iii--pay for physicians and other health-care
personnel''.
(5) Applicability dates.--The amendments made by this
subsection shall apply to any pay period of the Department of
Veterans Affairs beginning on or after the date that is 180
days after the date of the enactment of this Act.
(b) Modification and Clarification of Pay Grade for Optometrists.--
Section 7404 of title 38, United States Code, is amended--
(1) in subsection (a)(2)(A), by striking ``podiatrists, and
dentists'' and inserting ``podiatrists, optometrists, and
dentists''; and
(2) in subsection (b)--
(A) by striking ``podiatrist (dpm), and dentist''
and inserting ``podiatrist (dpm), optometrist (od), and
dentist'';
(B) by striking ``clinical chiropractor and
optometrist schedule,'' and inserting ``clinical
chiropractor schedule''; and
(C) by inserting ``optometrist grade'' after
``Podiatrist grade''.
(c) Retroactive Authority for Compensation.--
(1) In general.--The Secretary of Veterans Affairs may pay
retroactive compensation to a covered employee in an amount
that equals the amount of compensation that was authorized to
be paid to such covered employee during the period specified in
paragraph (2), but was deferred and paid to such employee in
the calendar year following the calender year in which such
compensation was authorized because the payment for such
compensation would have exceeded an applicable cap on annual
compensation.
(2) Period specified.--The period specified in this
paragraph is the period beginning on January 8, 2006, and
ending on December 31, 2017.
(3) Exclusion.--Compensation authorized under this
subsection shall not be included in the calculation of any
aggregate limit on compensation for a covered employee for the
year in which it is paid.
(4) Charging of compensation.--Compensation authorized
under this subsection shall be charged to the appropriate
medical care appropriation account of the Department of
Veterans Affairs for the fiscal year in which the work was
performed except as follows:
(A) In the case of an account that has closed
pursuant to section 1552 of title 31, United States
Code, the compensation shall be charged to a current
appropriation account in accordance with section 1553
of such title.
(B) In the case of an expired account that has not
closed, if charging the compensation to the expired
account would cause such account to have a negative
unliquidated or unexpended balance, the compensation
may be charged to a current appropriation account
available for the same purpose.
(5) Definitions.--In this subsection:
(A) The term ``compensation'' means any pay,
including salary, awards, and incentives.
(B) The term ``covered employee'' means a
physician, podiatrist, or dentist subject to market pay
under section 7431 of title 38, United States Code.
SEC. 143. REIMBURSEMENT OF AMBULANCE COST FOR CARE FOR CERTAIN RURAL
VETERANS.
(a) In General.--The Secretary of Veterans Affairs shall pay, or
reimburse a covered veteran for, the cost of transporting the veteran
by ambulance, including air ambulance, from a covered location to a
provider of the Department of Veterans Affairs, a non-Department
provider, or the nearest hospital that can meet the needs of the
veteran (including a hospital that compacts with the Indian Health
Service) for covered care.
(b) Amount Covered.--The maximum cumulative amount covered under
this section for a covered veteran is $46,000.
(c) Sunset.--This section shall cease to be effective on September
30, 2026.
(d) Definitions.--In this section:
(1) The term ``covered care'' means care for a veteran
eligible for care provided by the Department of Veterans
Affairs under title 38, United States Code, or any other law
administered by the Secretary of Veterans Affairs, even if the
care associated with the transport described in subsection (a)
is not authorized by the Department.
(2) The term ``covered location'' means a location that
is--
(A) in a State that is 100 miles or more from the
nearest medical center of the Department of Veterans
Affairs; and
(B) in an area rated as a 10 or higher under the
rural-urban commuting areas coding system of the
Department of Agriculture.
(3) The term ``covered veteran'' means a veteran who--
(A) has a service-connected disability rated by the
Secretary as between 0 and 30 percent disabling;
(B) is not eligible for payments or reimbursements
for beneficiary travel or other transportation under
the laws administered by the Secretary of Veterans
Affairs, other than under this section; and
(C) is not entitled to care or services under a
non-Department of Veterans Affairs health-plan
contract.
(4) The term ``health-plan contract'' has the meaning given
that term in section 1725 of title 38, United States Code.
(5) The term ``service-connected'' has the meaning given
that term in section 101 of such title.
SEC. 144. PILOT PROGRAM TO FURNISH DENTAL CARE FROM THE DEPARTMENT OF
VETERANS AFFAIRS TO CERTAIN VETERANS DIAGNOSED WITH
ISCHEMIC HEART DISEASE.
(a) In General.--Beginning not later than one year after the date
of the enactment of this Act, the Secretary of Veterans Affairs shall
carry out a two-year pilot program (in this section referred to as the
``pilot program'') under which the Secretary shall furnish covered care
to covered veterans through means that include the use of community
care.
(b) Locations.--
(1) In general.--The Secretary shall select not more than
four States in which to carry out the pilot program.
(2) Selection criteria.--In selecting States under
paragraph (1), the Secretary shall prioritize States in which--
(A) the Department of Veterans Affairs serves a
high proportion, as determined by the Secretary, of
veterans residing in rural or highly rural areas (as
determined through the use of the Rural-Urban Commuting
Areas coding system of the Department of Agriculture);
(B) dental clinics operated by the Department of
Veterans Affairs currently utilize teledentistry;
(C) the Department of Veterans Affairs does not
currently operate a dental clinic; or
(D) the Secretary determines a large percentage of
veterans enrolled in the system of annual patient
enrollment of the Department of Veterans Affairs
established and operated under paragraphs (1) or (2) of
section 1705(a) of title 38, United States Code, visit
emergency rooms for dental emergencies at high rates.
(c) Participation Limitation.--Participation in a pilot program
established pursuant to this section shall be limited to a covered
veteran who receives health care in a facility of the Department
located in a State selected under subsection (b).
(d) Use of Certain Methods To Provide Care.--
(1) Mobile dental clinics.--In carrying out the pilot
program, the Secretary shall test the efficacy of mobile dental
clinics to service rural areas that do not have a population
base to warrant a full-time clinic but where there are covered
veterans in need of dental care.
(2) Home-based dental care.--In carrying out the pilot
program, the Secretary shall test the efficacy of portable
dental care units to service rural veterans in their homes, as
the Secretary considers medically appropriate.
(e) Administration.--
(1) Community care network review.--
(A) In general.--Before commencing the pilot
program, the Secretary shall work with third party
administrators to conduct a review of dental providers
who are part of the community care network of the
Department in each State selected under subsection
(b)(1) to ensure--
(i) dental providers who are no longer
accepting patients from the Department--
(I) are not still listed as
providers accepting referrals from the
Department; and
(II) are not sent referrals from
the Department; and
(ii) dental providers participating in each
such network are capable of receiving an influx
of patients from the Department under the pilot
program.
(B) Expansion of network.--If, pursuant to a review
under subparagraph (A), the Secretary determines the
community care network in a State selected under
subsection (b)(1) is not capable of receiving an influx
of patients under the pilot program, the Secretary
shall coordinate with the Third Party Administrator for
such State to ensure the dental provider network of
such community care network is sufficiently expanded
before the initiation of the pilot program.
(2) Notice to covered veterans.--In carrying out the pilot
program, the Secretary shall inform all covered veterans in
States selected under subsection (b)(1) of the covered care
available under the pilot program.
(3) Loss of eligibility.--Any veteran participating in the
pilot program who ceases to be a covered veteran shall be
removed from the pilot program on the date that is 90 days
after the Secretary determines the participant is no longer a
covered veteran.
(4) Continuity of care.--
(A) In general.--Upon the termination of the pilot
program, the Secretary shall provide to all veterans
participating in the pilot program at the time of such
termination--
(i) information on how to enroll in the
dental insurance plan of the Department of
Veterans Affairs under section 1712C of title
38, United States Code;
(ii) if appropriate, information on the
VETSmile program of the Department of Veterans
Affairs, or any successor program; or
(iii) contact information for dental
providers in the surrounding community who
provide low- or no-cost dental care and whom
the Secretary has confirmed are available to
take on new patients.
(B) Continuation of treatment plan.--Any veteran
participating in the pilot program may continue to
receive services under the pilot program after the
termination of the pilot program to complete a
treatment plan commenced under the pilot program, as
determined necessary by the Secretary.
(f) Reports.--
(1) Annual report.--Not later than one year after the
commencement of the pilot program, and annually thereafter for
the duration of the pilot program, the Secretary of Veterans
Affairs shall submit to the Committees on Veterans' Affairs of
the House of Representatives and the Senate a report on the
pilot program that includes--
(A) an identification of the States participating
in the pilot program;
(B) a description of the implementation and
operation of the pilot program;
(C) the number of participants in the pilot
program, disaggregated by--
(i) State; and
(ii) disability rating;
(D) an identification of any barriers or challenges
to implementing the pilot program;
(E) aggregated feedback from participants in the
pilot program, including from interviews and surveys;
(F) the average annual cost of providing covered
care to a participant in the pilot program,
disaggregated by--
(i) State;
(ii) disability rating; and
(iii) whether the care was provided through
the community care network or through a
provider of the Department;
(G) an analysis of the communication and
collaboration of the Department with Third Party
Administrators and community care dental providers,
disaggregated by State;
(H) an analysis of any cost savings by the
Department with respect to the treatment of ischemic
heart disease;
(I) an assessment of the impact of the pilot
program on appointments for care, prescriptions,
hospitalizations, emergency room visits, wellness,
employability, satisfaction, and perceived quality of
life of covered veterans related to their diagnosis of
ischemic heart disease;
(J) an analysis and assessment of the efficacy of
mobile clinics and portable dental care units, to the
extent such modalities are used, to service the needs
of covered veterans under the pilot program;
(K) an analysis and assessment of the usage of
teledentistry to service the needs of covered veterans
under the pilot program, to include a cost benefit
analysis of such services; and
(L) such other matters as the Secretary considers
appropriate.
(2) Final report.--Not later than 90 days before the
completion of the pilot program, the Secretary shall submit to
the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report on the pilot program
that--
(A) includes the matters required under paragraph
(1);
(B) includes recommendations on whether the pilot
program should be continued, expanded, or adopted
throughout the Department; and
(C) indicates whether the Secretary requests action
by Congress to make the pilot program permanent.
(g) Impact on Community Care.--Participants in the pilot program
shall be able to access covered care in the community under section
1703 of title 38, United States Code.
(h) Definitions.--In this section:
(1) The term ``covered care'' means dental care that is
consistent with the dental services and treatment furnished by
the Secretary of Veterans Affairs to veterans pursuant to
section 1712(a)(1)(G) of title 38, United States Code.
(2) The term ``covered veteran'' means a veteran who--
(A) is enrolled in the system of annual patient
enrollment of the Department established and operated
under paragraphs (1) or (2) of section 1705(a) of title
38, United States Code;
(B) is not eligible for dental services and
treatment and related dental appliances under the laws
administered by the Secretary as of the date of the
enactment of this Act; and
(C) has a diagnosis of ischemic heart disease.
(3) The term ``Third Party Administrator'' has the meaning
given such term in section 1703F of such title.
SEC. 145. DOCUMENTATION OF PREFERENCES OF VETERANS FOR SCHEDULING OF
APPOINTMENTS FOR HEALTH CARE UNDER LAWS ADMINISTERED BY
SECRETARY OF VETERANS AFFAIRS.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall develop
a mechanism to solicit information regarding the preference of veterans
enrolled in the system of annual patient enrollment of the Department
of Veterans Affairs established and operated under section 1705(a) of
title 38, United States Code, for scheduling of appointments for health
care and related services under the laws administered by the Secretary,
including through non-Department providers.
(b) Documentation of Preference.--Preferences provided voluntarily
by a veteran pursuant to subsection (a) shall be documented on My
HealtheVet or another system designated by the Secretary that allows
the veteran to view and change such preferences at any time.
(c) Inclusion in Preference.--Preferences solicited under
subsection (a) shall include the following:
(1) How and when the veteran prefers to be contacted about
an appointment for health care.
(2) Whether the veteran prefers to schedule appointments
without the assistance of the Department, if able.
(3) Whether the veteran prefers to select a provider
without the assistance of the Department, if able.
(4) Whether the veteran prefers appointments to be
scheduled during certain days or times.
(d) Use of Preference.--The Secretary shall make the preferences
provided under subsection (a) easily accessible to medical support
assistants and other staff of the Department, or non-Department staff,
as the Secretary determines appropriate, who assist in the appointment
scheduling process.
(e) Deployment of Mechanism.--
(1) In general.--Beginning after the date on which the
Secretary develops the mechanism required under subsection (a),
the Secretary shall--
(A) test the mechanism in not fewer than three
geographically diverse Veterans Integrated Service
Networks; and
(B) gather feedback about the effectiveness of such
mechanism from veterans, medical support assistants,
staff and other stakeholders as the Secretary
determines appropriate.
(2) Limitation.--The Secretary may not implement such
mechanism across the Veterans Health Administration of the
Department before the Secretary addresses the feedback
described in paragraph (1)(B).
SEC. 146. STAFFING MODEL AND PERFORMANCE METRICS FOR CERTAIN EMPLOYEES
OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Staffing Model.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall--
(A) develop, validate, and implement a staffing
model for the Office of Integrated Veteran Care of the
Department of Veterans Affairs, or successor office,
Veterans Integrated Services Networks, and medical
centers of the Department that includes appropriate
target staffing levels nationally, regionally, and
locally to ensure timely access to care and effectively
oversee the provision of care by the Department,
whether at a facility of the Department or through a
non-Department provider; and
(B) provide to Congress a briefing on such staffing
model, which shall include--
(i) the metrics and measures used by the
Secretary in developing such staffing model;
(ii) an analysis of how such staffing model
compares to the staffing models of other
relevant Government-owned and private sector
health care systems; and
(iii) an estimate of the portion of the
roles in such staffing model that will be
filled by contracted staff at any given time.
(2) Report on implementation of staffing model.--Not later
than one year after the date on which the Secretary implements
the staffing model required under paragraph (1), the Secretary
shall submit to Congress and the Comptroller General of the
United States a report containing--
(A) an update on such implementation; and
(B) information on the outcomes yielded by such
staffing model in terms of improved access to care for
veterans and improved compliance with relevant laws,
regulations, policy directives, and guidance governing
access to care.
(b) Performance Metrics.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary shall develop and
implement a plan, with an appropriate tracking system, to
incorporate appropriate standardized performance metrics and
oversight measures within the performance appraisal systems for
employees of the Department specified in paragraph (2).
(2) Employees of the department specified.--Employees of
the Department specified in this paragraph are employees who
are responsible for ensuring timely access to care from the
Department, compliance with relevant statutes and regulations
relating to the provision of care, including section 1703 of
title 38, United States Code, and overseeing the provision of
care, whether at a facility of the Department or through a non-
Department provider, including employees within the Office of
Integrated Veteran Care of the Department, or successor office,
employees of a Veterans Integrated Service Network, and
employees of a medical center of the Department.
(3) Report on implementation of performance metrics.--Not
later than one year after implementing the performance metrics
required under paragraph (1), the Secretary shall submit to
Congress and the Comptroller General of the United States a
report containing--
(A) an update on such implementation; and
(B) information on the outcomes yielded by such
performance metrics in terms of improved access to care
for veterans and improved compliance with relevant
laws, policy directives, and guidance governing access
to care.
(c) GAO Report.--Not later than two years after the later of the
date on which the Comptroller General receives the report under
subsection (a)(2) or the report under subsection (b)(3), the
Comptroller General shall submit to Congress a report that includes--
(1) an assessment of the performance of the Office of
Integrated Veteran Care of the Department, or successor office,
in improving access to care for veterans in facilities of the
Department and pursuant to section 1703 of title 38, United
States Code; and
(2) such recommendations as the Comptroller General
considers appropriate with respect to improving access to the
care described in paragraph (1) for veterans.
SEC. 147. ONLINE HEALTH EDUCATION PORTAL FOR VETERANS ENROLLED IN
PATIENT ENROLLMENT SYSTEM OF DEPARTMENT OF VETERANS
AFFAIRS.
Not later than one year after the date of the enactment of this
Act, the Secretary of Veterans Affairs shall establish, on an Internet
website of the Department, a health education portal that includes
interactive educational modules to ensure veterans enrolled in the
patient enrollment system of the Department of Veterans Affairs
established and operated under section 1705(a) of title 38, United
States Code, understand the basic health care eligibilities and
entitlements of veterans under the laws administered by the Secretary,
including under the Veterans Community Care Program under section 1703
of such title.
SEC. 148. LIMITATION ON DETAIL OF DIRECTORS OF MEDICAL CENTERS OF
DEPARTMENT OF VETERANS AFFAIRS TO DIFFERENT POSITIONS.
(a) Notification.--
(1) In general.--Not later than 90 days after detailing a
director of a medical center of the Department of Veterans
Affairs to a different position within the Department, the
Secretary of Veterans Affairs shall notify the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives of such detail.
(2) Matters to be included.--The notification required by
paragraph (1) shall include, with respect to a director of a
medical center who is detailed to a different position within
the Department, the following information:
(A) The location at which the director is detailed.
(B) The position title of the detail.
(C) The estimated time the director is expected to
be absent from their duties at the medical center.
(D) Such other information as the Secretary may
determine appropriate.
(b) Appointment of Acting Director.--Not later than 120 days after
detailing a director of a medical center of the Department to a
different position within the Department, the Secretary shall appoint
an individual as acting director of such medical center with all of the
authority and responsibilities of the detailed director.
(c) Update on Detail.--Not later than 120 days after detailing a
director of a medical center of the Department to a different position
within the Department, and not less frequently than every 30 days
thereafter while the detail is in effect or while the director position
at the medical center is vacant, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives an update regarding
the status of the detail.
(d) Return to Position or Reassignment.--
(1) In general.--Except as provided in paragraph (2), not
later than 180 days after detailing a director of a medical
center of the Department to a different position within the
Department, for a reason other than an ongoing investigation or
administrative action with respect to the director, the
Secretary shall--
(A) return the individual to the position as
director of the medical center; or
(B) reassign the individual from the position as
director of the medical center and begin the process of
hiring a new director for such position.
(2) Waiver.--
(A) In general.--The Secretary may waive the
requirement under paragraph (1) with respect to an
individual for successive 90-day increments for a total
period of not more than 540 days from the original date
the individual was detailed away from their position as
director of a medical center.
(B) Notification.--Not later than 30 days after
exercising a waiver under subparagraph (A), the
Secretary shall notify Congress of the waiver and
provide to Congress information as to why the waiver is
necessary.
SEC. 149. NATIONAL VETERAN SUICIDE PREVENTION ANNUAL REPORT.
(a) National Veteran Suicide Prevention Annual Report.--
(1) In general.--Not later than 18 months after the date of
the enactment of this Act, and not later than September 30 of
each year thereafter, the Secretary of Veterans Affairs shall
submit to the appropriate congressional committees and publish
on a publicly available website of the Department of Veterans
Affairs a report to be known as the ``National Veteran Suicide
Prevention Annual Report''.
(2) Extension.--
(A) In general.--If the Secretary requires an
extension of the deadline for a report under subsection
(a), the Secretary shall submit to the appropriate
congressional committees a written request for such an
extension.
(B) Elements.--Each written request under paragraph
(1) for an extension for a report shall include the
following:
(i) The rationale for the delay in the
submission of the report.
(ii) An explanation of the need for an
extension.
(iii) A proposed amended date for the
submission and publication of the report.
(3) Briefing.--With respect to each report required under
paragraph (1), the Secretary shall, before the date on which
the Secretary submits such report, provide to the appropriate
congressional committees a briefing on such report.
(4) Elements.--
(A) In general.--Each report required under
paragraph (1) shall include--
(i) the findings of the national analysis
of veteran suicide rates for the latest year
for which data is available;
(ii) an identification of trends, if any,
demonstrated by such data; and
(iii) a comparison of such data to data on
veteran suicide rates during preceding years.
(B) Additional elements.--Each report under
paragraph (1) shall include, for the year covered by
the report, the following:
(i) Suicide rates of veterans disaggregated
by age, gender, and race or ethnicity.
(ii) Trends in suicide rates of veterans
compared to engagement of those veterans with
health care from the Veterans Health
Administration, including an examination of
trends in suicide rates or deaths among--
(I) veterans who have recently
received health care from the Veterans
Health Administration as compared to
veterans who have never received health
care from the Veterans Health
Administration;
(II) veterans who are enrolled in
the patient enrollment system of the
Department of Veterans Affairs under
section 1705(a) of title 38, United
States Code, as compared to veterans
who have never enrolled in such system;
(III) veterans who have recently
used services from a Vet Center as
compared to veterans who have never
used such services;
(IV) to the extent practicable,
veterans who have a diagnosis of
substance use disorder; and
(V) other groups of veterans
relating to engagement with health care
from the Veterans Health
Administration, as the Secretary
considers practicable.
(iii) To the extent practicable, trends in
suicide rates of veterans compared to
engagement of those veterans with benefits from
the Veterans Benefits Administration, including
an examination of trends in suicide rates or
deaths among--
(I) veterans who are currently
using, have previously used, or have
never used educational assistance under
the laws administered by the Secretary;
(II) veterans who are currently
receiving, have previously received, or
have never received services or
assistance under chapter 31 of title
38, United States Code;
(III) with respect to compensation
under chapter 11 of such title--
(aa) veterans who were
recipients of such compensation
as compared to veterans who
never applied for such
compensation prior to death;
(bb) veterans who had a
claim denied for such
compensation prior to death;
(cc) veterans who had a
pending claim for such
compensation at time of death;
and
(dd) veterans who had an
entitlement for such
compensation reduced prior to
death;
(IV) veterans who are currently
receiving or have never received
pension under chapter 15 of title 38,
United States Code;
(V) veterans who are currently
using, have recently used, or have
never used programs or services
provided by the Homeless Programs
Office of the Department, including an
examination of trends in suicide rates
or deaths among veterans who made
contact with such office but were
denied or deemed ineligible for any
such program or service;
(VI) with respect to housing loans
guaranteed by the Secretary under
chapter 37 of title 38, United States
Code, veterans who are current
recipients of, were recent recipients
of, or have never received such a loan;
(VII) veterans owing debts to the
Department;
(VIII) veterans who were involved
in a veterans treatment court program,
whether they graduated successfully or
not; and
(IX) veterans who were successfully
contacted, unsuccessfully contacted, or
never contacted by the Department
through the Solid Start program under
section 6320 of title 38, United States
Code.
(C) Strategy and recommendations.--
(i) Initial report.--The initial report
under paragraph (1) shall include a strategy
and recommendations developed by the Secretary
of Veterans Affairs, in collaboration with the
Director of the Centers for Disease Control and
Prevention and the Secretary of Defense, for--
(I) improving data collection at
the State and local levels to
accurately capture suicide deaths of
veterans;
(II) improving the timeliness,
efficacy, and standardization of data
reporting on suicide deaths of veterans
at the Federal level, including by the
Centers for Disease Control and
Prevention, the Department of Defense,
and the Department of Veterans Affairs;
(III) improving the timeliness of
identification and analysis of suicide
deaths of veterans by Federal agencies,
including the Centers for Disease
Control and Prevention, the Department
of Defense, and the Department of
Veterans Affairs; and
(IV) any other necessary process
improvements for improving the
timeliness, efficacy, and
standardization of reporting of data
relating to suicide deaths of veterans,
particularly with respect to the annual
report under this section.
(ii) Subsequent reports.--Each report after
the initial report under paragraph (1) shall
include updates on actions taken to meet the
strategy and recommendations developed under
subparagraph (A).
(5) Definitions.--In this subsection:
(A) The term ``appropriate congressional
committees'' means the Committees on Veterans' Affairs
of the Senate and the House of Representatives.
(B) The term ``Vet Center'' means a center for
readjustment counseling and related mental health
services for veterans under section 1712A of title 38,
United States Code.
(b) Independent Assessment of National Veteran Suicide Prevention
Annual Report.--
(1) In general.--Not later than 90 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall enter into one or more contracts with a private sector
entity described in paragraph (5) to conduct an independent
assessment of the National Veteran Suicide Prevention Annual
Report required under subsection (a).
(2) Frequency.--The private sector entity or entities
carrying out the assessment required under paragraph (1) shall
complete such assessment not later than 240 days after entering
into the contract described in such subsection and not less
frequently than every five years thereafter.
(3) Elements.--Each assessment required under paragraph (1)
shall analyze the following:
(A) The methodology used by the Department to
track, analyze, categorize, and report suicide deaths
and suicide rates among veterans.
(B) Whether data sources used by the Department to
compile data on suicide deaths and suicide rates among
veterans are accurately reflecting such data.
(C) Vulnerabilities in the methodology used by the
Department that could lead to inaccurate counting of
suicide deaths and suicide rates among veterans.
(D) The ability of the Department to cross-
reference suicide deaths and suicide rates among
veterans with trends in usage of programs of the
Veterans Health Administration or the Veterans Benefits
Administration or other programs that could serve as
widespread protective factors against suicide.
(E) Improvements that could be made to ensure the
National Veteran Suicide Prevention Annual Report
required under subsection (a) is accurate and
comprehensive and provides insights for making
improvements to the suicide prevention efforts of the
Department.
(4) Report on assessment.--
(A) Report on findings and recommendations.--Not
later than 60 days after completing an assessment
required by paragraph (1), the private sector entity or
entities carrying out the assessment shall submit to
the Secretary of Veterans Affairs and the Committees on
Veterans' Affairs of the Senate and the House of
Representatives a report on the findings and
recommendations of the private sector entity or
entities with respect to such assessment.
(B) Report on planned improvements.--Not later than
60 days after receiving a report under paragraph (1)
with respect to an assessment required by paragraph
(1), the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and the House of
Representatives a report on how the Department plans to
improve the National Veteran Suicide Prevention Annual
Report required under subsection (a) based on such
assessment.
(5) Private sector entity described.--A private sector
entity described in this paragraph is a private entity that--
(A) specializes in analyzing large-scale
organizational data collection and analysis efforts,
especially with respect to the health care sector; and
(B) has experience and proven outcomes in
optimizing the accuracy and comprehensiveness of data
collection and analysis related to suicide.
(c) Report on Additional Benefits and Services From Department of
Veterans Affairs To Prevent Veteran Suicide.--
(1) In general.--Not later than three years after the date
of the enactment of this Act, the Secretary of Veterans Affairs
shall submit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives and publish on a
publicly available website of the Department of Veterans
Affairs a report that analyzes which benefits and services
under the laws administered by such Secretary, including such
benefits and services furnished by the Veterans Benefits
Administration, have the greatest impact on the prevention of
suicide among veterans, including recommendations for potential
expansion of services and benefits to reduce the number of
veteran suicides.
(2) Assessment of solid start program.--The report required
by paragraph (1) shall include an analysis of the effectiveness
of the Solid Start program under section 6320 of title 38,
United States Code, on prevention of suicide among veterans.
(d) Toolkit for State and Local Coroners and Medical Examiners on
Best Practices for Identifying and Reporting on Suicide Deaths of
Veterans.--
(1) In general.--The Secretary of Veterans Affairs, in
collaboration with the Director of the Centers for Disease
Control and Prevention, shall develop a toolkit for State and
local coroners and medical examiners that contains best
practices for--
(A) accurately identifying and reporting suicide
deaths of veterans, including how to identify veteran
status; and
(B) reporting such deaths to the Centers for
Disease Control and Prevention and other applicable
entities.
(2) Availability.--Not later than two years after the date
of the enactment of this Act, the Secretary shall make the
toolkit developed under paragraph (1) available on a publicly
available website of the Department of Veterans Affairs.
(3) Outreach.--The Secretary, in collaboration with the
Director of the Centers for Disease Control and Prevention,
shall conduct outreach to appropriate State and local agencies
to promote the availability and use of the toolkit developed
under paragraph (1).
SEC. 150. REPORT ON PHYSICAL INFRASTRUCTURE REQUIRED BY MEDICAL
FACILITIES OF DEPARTMENT OF VETERANS AFFAIRS TO PROVIDE
DENTAL CARE SERVICES.
Not later than one year after the date of the enactment of this
Act, the Secretary of Veterans Affairs shall submit to the Committees
on Veterans' Affairs of the Senate and the House of Representatives a
report, for each medical center or other relevant health care facility
of the Department of Veterans Affairs, that includes--
(1) an identification of the physical infrastructure,
including new facilities, renovations, remodels, leases, or
other infrastructure, such medical center or health care
facility requires to provide dental care services to veterans
eligible for such services under the laws administered by the
Secretary; and
(2) an analysis of the physical infrastructure such medical
center or health care facility would require if a greater
number of veterans became eligible for such dental care
services pursuant to a modification of the laws administered by
the Secretary.
SEC. 151. COMPTROLLER GENERAL REPORT ON CERTAIN ORAL HEALTH CARE
PROGRAMS UNDER LAWS ADMINISTERED BY SECRETARY OF VETERANS
AFFAIRS.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Committees on Veterans' Affairs of the Senate and
the House of Representatives a report on the status of the oral health
care programs of the Department of Veterans Affairs, that includes an
assessment of--
(1) any issues with information technology programs,
including Dental Record Manager Plus, that affect dental care
staff of the Department;
(2) the implementation of the dental insurance plan of the
Department under section 1712C of title 38, United States Code;
(3) the implementation and expansion of the VETSmile
program of the Department;
(4) barriers preventing the Department from expanding
dental care eligibility to all veterans with ischemic heart
disease, including such barriers relating to physical
infrastructure, workforce, and cost of such dental care;
(5) barriers preventing dental clinics of the Department,
if any, from adopting teledentistry;
(6) the demographic makeup of veterans eligible for dental
care paid for by the Department as of the commencement of the
pilot program under section 145 of this Act, including
information on--
(A) age;
(B) gender;
(C) race or ethnicity, disaggregated by--
(i) membership in an Indian Tribe; and
(ii) the major race groups used in the
decennial census;
(D) employment status; and
(E) location of residence, disaggregated by rural,
highly rural, and urban locations; and
(7) changes to such demographic makeup if any, that would
result from an expansion of eligibility for dental care under
the laws administered by the Secretary to all veterans with
ischemic heart disease including changes to demographics
specified in paragraph (6).
(b) Third Party Administrator Defined.--In this section, the term
``Third Party Administrator'' means an entity that manages a provider
network and performs administrative services related to such network
under section 1703 of title 38, United States Code.
SEC. 152. REVIEW OF WORKFLOWS ASSOCIATED WITH PROCESSING REFERRALS
BETWEEN FACILITIES OF THE VETERANS HEALTH ADMINISTRATION.
(a) In General.--The Secretary of Veterans Affairs shall conduct a
review of the workflows directly associated with processing referrals
of patients between facilities of the Veterans Health Administration of
the Department of Veterans Affairs to identify specific delays or
bottlenecks in such referrals.
(b) Elements of Review.--The review required under subsection (a)
shall include a review of--
(1) the interfacility consult management guidance of the
Veterans Health Administration that assists facilities
described in subsection (a) in constructing a workflow for
consults between such facilities; and
(2) the roles and responsibilities of the individuals
involved in the consult management process in managing such
consults, including the role of the referral coordination team.
(c) Report.--Not later than 180 days after the date of the
enactment of this Act, the Secretary shall submit to Congress a report
on the results of the review required under subsection (a).
SEC. 153. PLAN FOR TIMELY SCHEDULING OF APPOINTMENTS AT MEDICAL
FACILITIES OF DEPARTMENT OF VETERANS AFFAIRS.
(a) Plan Required.--To improve responsiveness in the provision of
hospital care and medical services at medical facilities of the
Department of Veterans Affairs, the Secretary of Veterans Affairs shall
develop a plan to--
(1) ensure that whenever a covered veteran contacts the
Department by telephone to request the scheduling of an
appointment for care or services for the covered veteran at
such a facility, the scheduling for the appointment occurs
during that telephone call (regardless of the prospective date
of the appointment being scheduled); and
(2) provide timely and, where applicable, same-day
scheduling for an appointment described in paragraph (1).
(b) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary shall submit to the Committees on
Veterans' Affairs of the House of Representatives and the Senate a
report on the plan under subsection (a).
(c) Covered Veteran Defined.--In this section, the term ``covered
veteran'' means a veteran who is enrolled in the system of patient
enrollment of the Department under section 1705(a) of title 38, United
States Code.
SEC. 154. AUTHORIZATION OF APPROPRIATIONS TO SUPPORT INITIATIVES FOR
MOBILE MAMMOGRAPHY SERVICES FOR VETERANS.
There is authorized to be appropriated to the Secretary of Veterans
Affairs $5,000,000 for fiscal year 2025 for the Office of Women's
Health of the Department of Veterans Affairs under section 7310 of
title 38, United States Code, to be used by the Secretary to expand
access of women veterans to--
(1) mobile mammography initiatives;
(2) advanced mammography equipment; and
(3) outreach activities to publicize those initiatives and
equipment.
TITLE II--ECONOMIC OPPORTUNITY MATTERS
Subtitle A--Educational Assistance
SEC. 201. TEMPORARY EXPANSION OF ELIGIBILITY FOR MARINE GUNNERY
SERGEANT JOHN DAVID FRY SCHOLARSHIP.
(a) In General.--The Secretary of Veterans Affairs shall treat an
individual described in subsection (b) as a covered individual
described in section 3311(b) of title 38, United States Code.
(b) Covered Individual Described.--An individual described in this
subsection is an individual who is the child or spouse of a person--
(1) who dies from a service-connected disability during the
120-day period immediately following the day on which the
person was discharged or released from duty as a member of the
Armed Forces (without regard to whether such duty was active
duty); and
(2)(A) who received an honorable discharge; or
(B) whose service in the Armed Forces is characterized by
the Secretary concerned as honorable service.
(c) Applicability.--This section shall apply with respect to--
(1) deaths that occur before, on, or after the date of the
enactment of this Act; and
(2) a quarter, semester, or term, as applicable,
commencing--
(A) on or after August 1, 2024; and
(B) before October 1, 2026.
SEC. 202. REMOVAL OF EXPIRATION ON ENTITLEMENT TO MARINE GUNNERY
SERGEANT JOHN DAVID FRY SCHOLARSHIP FOR SURVIVING
SPOUSES.
Section 3311(f) of title 38, United States Code, is amended--
(1) by striking paragraph (2);
(2) by redesignating paragraphs (3) through (5) as
paragraphs (2) through (4), respectively;
(3) in paragraph (2), as redesignated by paragraph (2) of
this section, by striking ``in paragraph (4)'' and inserting
``in paragraph (3)''; and
(4) in paragraph (3)(A), as redesignated by paragraph (2)
of this section, by striking ``under paragraph (3)'' and
inserting ``under paragraph (2)''.
SEC. 203. SOLE LIABILITY FOR TRANSFERRED EDUCATIONAL ASSISTANCE BY AN
INDIVIDUAL WHO FAILS TO COMPLETE A SERVICE AGREEMENT.
Subsection (i) of section 3319 of title 38, United States Code, is
amended--
(1) in paragraph (1)--
(A) by striking ``In the event'' and inserting
``Subject to paragraph (2), in the event''; and
(B) by inserting ``of this title'' after ``section
3685'';
(2) in subparagraph (A) of paragraph (2)--
(A) in the heading, by striking ``In general'' and
inserting ``Sole liability''; and
(B) by striking ``under paragraph (1)'' and
inserting ``for which the individual shall be solely
liable to the United States for the amount of the
overpayment for purposes of section 3685 of this
title''; and
(3) in subparagraph (B) of paragraph (2)--
(A) in the matter preceding clause (i), by striking
``Subparagraph (A) shall not apply'' and inserting
``Neither the individual nor the dependent shall be
liable to the United States for the amount of the
overpayment for purposes of section 3685 of this
title''; and
(B) in clause (ii), by inserting ``of this title''
after ``section 3311(c)(4)''.
SEC. 204. NOTICE TO EDUCATIONAL INSTITUTIONS OF RISK-BASED SURVEYS.
Section 3673A(d) of title 38, United States Code, is amended by
striking ``one business day'' and inserting ``two business days''.
SEC. 205. RELATIONSHIP OF PARTICIPATION BY AN EDUCATIONAL INSTITUTION
IN CERTAIN FEDERAL STUDENT FINANCIAL AID PROGRAMS TO
APPROVAL OF SUCH INSTITUTION FOR PURPOSES OF DEPARTMENT
OF VETERANS AFFAIRS EDUCATIONAL ASSISTANCE PROGRAMS.
Paragraph (4) of section 3675(b) of title 38, United States Code,
is amended to read as follows:
``(4) The educational institution--
``(A) is approved and participates in a program
under title IV of the Higher Education Act of 1965 (20
U.S.C. 1070 et seq.); or
``(B) does not participate in such a program and
the Secretary has waived the requirement under this
paragraph with respect to the educational institution,
and submits to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of
the House of Representatives notice of such waiver,
because the Secretary determines that the educational
institution--
``(i) elects not to participate in such a
program;
``(ii) cannot participate in such a
program; or
``(iii) is in the process of making a good-
faith effort to submit an initial application
for approval to participate in such a program,
except that a waiver under this clause may not
be provided for a period of longer than 36
months.''.
SEC. 206. EXPANSION OF DEPARTMENT OF VETERANS AFFAIRS OVERSIGHT OF
CERTAIN EDUCATIONAL INSTITUTIONS.
(a) Additional Requirement for Approval.--Section 3675(b) of title
38, United States Code, as amended by section 205, is further amended
by adding at the end the following new paragraph:
``(5) The educational institution agrees to, not later than
30 days after any date on which such educational institution
becomes subject to an action or event described in section
3673(e)(3) of this title, submit to the State approving agency,
or the Secretary when acting in the role of a State approving
agency, a notification of such action or event in such form and
containing such information as the Secretary determines
appropriate.''.
(b) Additional Requirement for Approval of Nonaccredited Courses.--
(1) In general.--Section 3676(c) of such title is amended--
(A) by redesignating paragraphs (14) through (16)
as paragraphs (15) through (17), respectively; and
(B) by inserting after paragraph (13) the following
new paragraph:
``(14) The institution agrees to, not later than 30 days
after any date on which such institution becomes subject to an
action or event described in section 3673(e)(3) of this title,
submit to the State approving agency, or the Secretary when
acting in the role of a State approving agency, a notification
of such action or event in such form and containing such
information as the Secretary determines appropriate.''.
(2) Conforming amendments.--Such title is further amended--
(A) in section 3672(b)(2)(C), by striking
``paragraph (14) or (15)'' and inserting ``paragraph
(15) or (16)'';
(B) in section 3675(b)(3), by striking ``(14),
(15), and (16)'' and inserting ``(15), (16), and
(17)'';
(C) in section 3679(d), by striking ``described in
paragraph (14) or (15)'' and inserting ``described in
paragraph (15) or (16)''; and
(D) in section 3680A(a)(4)(C)(iii), by striking
``section 3676(c)(14) and (15)'' and inserting
``section 3676(c)(15) and (16)''.
(c) Additional Grounds for Suspension of Approval.--Section
3679(f)(1) of such title is amended by adding at the end the following
new subparagraph:
``(I) Comply with the notification requirements under
sections 3675(b)(5) and 3676(c)(14) of this title, when
applicable.''.
(d) Deadline for Risk-Based Surveys Database.--The Secretary of
Veterans Affairs shall establish the database required under section
3673A(c) of title 38, United States Code, by not later than 180 days
after the date of the enactment of this Act.
SEC. 207. REQUIREMENT THAT EDUCATIONAL INSTITUTIONS APPROVED FOR
PURPOSES OF DEPARTMENT OF VETERANS AFFAIRS EDUCATIONAL
ASSISTANCE PROGRAMS PROVIDE DIGITAL OFFICIAL TRANSCRIPTS.
(a) Requirement.--Section 3675(b) of title 38, United States Code,
as amended by sections 205 and 206, is further amended by adding at the
end the following new paragraph:
``(6) The educational institution makes available to each
eligible person or veteran a copy of the person or veteran's
official transcript in a digital format.''.
(b) Conforming Amendments.--
(1) Approval of courses.--Section 3672(b)(2)(A) of such
title is amended by striking ``(b)(1) and (b)(2)'' and
inserting ``paragraphs (1), (2), and (6) of section 3675(b)''.
(2) Approval of nonaccredited courses.--Section 3676(c) of
such title is amended--
(A) by redesignating paragraph (17) as paragraph
(18); and
(B) by inserting after paragraph (16) the following
new paragraph (17):
``(17) In the case of a course that leads to a standard
college degree, the educational institution satisfies the
requirements of section 3675(b)(6) of this title.''.
(3) Conforming amendments.--Section 3675(b)(3) of such
title is amended by striking ``(15), (16), and (17)'' and
inserting ``(15), (16), and (18)''.
(c) Effective Date.--The amendments made by this section shall take
effect on August 1, 2025, and apply with respect to a quarter,
semester, or term, as applicable, commencing on or after such date.
SEC. 208. PAYMENT OF FULL MONTHLY HOUSING STIPEND FOR VETERANS ENROLLED
IN FINAL SEMESTER USING EDUCATIONAL ASSISTANCE UNDER
POST-9/11 EDUCATIONAL ASSISTANCE PROGRAM.
(a) Housing Allowance.--Section 3680(a)(3) of title 38, United
States Code, is amended--
(1) by redesignating subparagraphs (A) and (B) as clauses
(i) and (ii), respectively (and by redesignating each
subordinate provision and the margins thereof accordingly);
(2) by striking ``Notwithstanding paragraph (1)'' and
inserting ``(A) Notwithstanding paragraph (1)'';
(3) by striking ``, including a monthly housing stipend
described in section 3313(c) of this title,''; and
(4) by adding at the end the following new subparagraph
(B):
``(B) For purposes of providing a monthly housing stipend described
in section 3313(c) to an eligible veteran or eligible person for whom
the Secretary is providing educational assistance under chapter 33 of
this title during a period that is the last semester, term, or academic
period pursuant to subparagraph (A), the Secretary shall treat the
veteran or person as pursuing a program of education on a full-time
basis.''.
(b) Application.--The amendments made by subsection (a) shall take
effect on the date of the enactment of this Act and apply with respect
to a quarter, semester, or term, as applicable, commencing on or after
August 1, 2024.
SEC. 209. MODIFICATION OF RULES FOR APPROVAL OF COMMERCIAL DRIVER
EDUCATION PROGRAMS FOR PURPOSES OF EDUCATIONAL ASSISTANCE
PROGRAMS OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Section 3680A(e) of title 38, United States Code,
is amended--
(1) by redesignating paragraphs (1) through (3) as
subparagraphs (A) though (C), respectively;
(2) in the matter before subparagraph (A), as redesignated
by paragraph (1), by inserting ``(1)'' before ``The
Secretary'';
(3) in paragraph (1)(B), as redesignated by paragraph (1),
by inserting ``except as provided in paragraph (2),'' before
``the course''; and
(4) by adding at the end the following new paragraph (2):
``(2)(A) Subject to this paragraph, a commercial driver education
program is exempt from paragraph (1)(B) for a branch of an educational
institution if the commercial driver education program offered at the
branch by the educational institution--
``(i) is appropriately licensed; and
``(ii)(I) the branch is located in a State in which the
same commercial driver education program is offered by the same
educational institution at another branch of that educational
institution in the same State that is approved for purposes of
this chapter by a State approving agency or the Secretary when
acting in the role of a State approving agency; or
``(II)(aa) the branch is located in a State in which the
same commercial driver education program is not offered at
another branch of the same educational institution in the same
State; and
``(bb) the branch has been operating for a period of at
least one year using the same curriculum as a commercial driver
education program offered by the educational institution at
another location that is approved for purposes of this chapter
by a State approving agency or the Secretary when acting in the
role of a State approving agency.
``(B)(i) In order for a commercial driver education program of an
educational institution offered at a branch described in paragraph
(1)(B) to be exempt under subparagraph (A) of this paragraph, the
educational institution shall submit to the Secretary each year that
paragraph (1)(B) would otherwise apply a report that demonstrates that
the curriculum at the new branch is the same as the curriculum at the
primary location.
``(ii) Reporting under clause (i) shall be submitted in accordance
with such requirements as the Secretary shall establish in consultation
with the State approving agencies.
``(C)(i) The Secretary may withhold an exemption under subparagraph
(A) for any educational institution or branch of an educational
institution as the Secretary considers appropriate.
``(ii) In making any determination under clause (i), the Secretary
may consult with the Secretary of Transportation on the performance of
a provider of a commercial driver program, including the status of the
provider within the Training Provider Registry of the Federal Motor
Carrier Safety Administration when appropriate.
``(D) The Secretary shall submit to the Committees on Veterans'
Affairs of the Senate and the House of Representatives a notification
not later than 30 days after the Secretary grants an exemption under
this paragraph. Such notification shall identify the educational
institution and branch of such educational institution granted such
exemption.''.
(b) Implementation.--
(1) Establishment of requirements.--Not later than 180 days
after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall establish requirements under section
3680A(e)(2)(B)(ii) of such title, as added by subsection (a).
(2) Rulemaking.--In promulgating any rules to carry out
paragraph (2) of section 3680A(e) of title 38, United States
Code, as added by subsection (a), the Secretary of Veterans
Affairs shall consult with State approving agencies.
(3) Applicability.--The amendments made by subsection (a)
shall apply to commercial driver education programs on and
after the day that is 365 days after the date on which the
Secretary establishes the requirements under paragraph (1) of
this subsection.
(c) Comptroller General of the United States Study.--Not later than
365 days after the date of the enactment of this Act, the Comptroller
General of the United States shall--
(1) conduct a study to--
(A) ascertain the effects of the amendments made by
subsection (a); and
(B) the feasibility and advisability of similarly
amending the rules for approval of programs of
education for other vocational programs of education;
and
(2) submit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives a report on the
findings of the Comptroller General with respect to such study.
SEC. 210. PROVISION OF CERTIFICATES OF ELIGIBILITY AND AWARD LETTERS
USING ELECTRONIC MEANS.
(a) In General.--Chapter 36 of title 38, United States Code, is
amended by inserting after section 3698 the following new section (and
conforming the table of sections at the beginning of such chapter
accordingly):
``Sec. 3698A. Provision of certificates of eligibility and award
letters using electronic means
``(a) Requirement.--Except as provided by subsection (b), the
Secretary shall provide to an individual the following documents using
electronic means:
``(1) A certificate of eligibility for the entitlement of
the individual to covered educational assistance.
``(2) An award letter regarding the authorization of the
individual to receive covered educational assistance.
``(b) Election To Opt Out.--An individual may elect to receive the
documents specified in subsection (a) by mail rather than through
electronic means under subsection (a). An individual may revoke such an
election at any time, by means prescribed by the Secretary.
``(c) Covered Educational Assistance.--In this section, the term
`covered educational assistance' means educational assistance under
chapter 30, 33, or 35 of this title, or section 3699C of this title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
3698 the following new item:
``3698A. Provision of certificates of eligibility and award letters
using electronic means.''.
SEC. 211. RETROACTIVE EFFECTIVE DATE OF LAW REGARDING CHARGE TO
ENTITLEMENT TO EDUCATIONAL ASSISTANCE FOR INDIVIDUALS WHO
DO NOT TRANSFER CREDITS FROM CERTAIN CLOSED OR
DISAPPROVED PROGRAMS OF EDUCATION.
Section 3699(c)(2) of title 38, United States Code, is amended by
striking subparagraph (C) and inserting the following new subparagraph
(C):
``(C) This paragraph, including clauses (ii) and (iii) of
subparagraph (A), shall apply with respect to the closure or
discontinuation of a course or program of education, as described in
subsection (b)(1), that occurs during the period beginning on August 1,
2021, and ending on September 30, 2025.''.
SEC. 212. DEPARTMENT OF VETERANS AFFAIRS HIGH TECHNOLOGY PROGRAM.
(a) High Technology Program.--
(1) In general.--Chapter 36 of title 38, United States
Code, as amended by section 210, is amended by adding at the
end the following new section:
``Sec. 3699C. High technology program
``(a) Establishment.--(1) The Secretary shall carry out a program
under which the Secretary provides covered individuals with the
opportunity to enroll in high technology programs of education that the
Secretary determines provide training or skills sought by employers in
a relevant field or industry.
``(2) Not more than 4,000 covered individuals may participate in
the program under this section in any fiscal year.
``(b) Amount of Assistance.--(1) The Secretary shall provide, to
each covered individual who pursues a high technology program of
education under this section, educational assistance in amounts equal
to the amounts provided under section 3313(c)(1) of this title,
including, except as provided in paragraph (3), with respect to the
housing stipend described in that section and in accordance with the
treatment of programs that are distance learning and programs that are
less than half-time.
``(2) Under paragraph (1), the Secretary shall provide such amounts
of educational assistance to a covered individual for each of the
following:
``(A) A high technology program of education.
``(B) A second such program if--
``(i) the second such program begins at least 18
months after the covered individual graduates from the
first such program; and
``(ii) the covered individual uses educational
assistance under chapter 33 of this title to pursue the
second such program.
``(3) No covered individual may receive a housing stipend under
this subsection for any month if such individual is in receipt of a
housing stipend under chapter 33 of this title for that month.
``(c) Contracts.--(1) For purposes of carrying out subsection (a),
the Secretary shall seek to enter into contracts with any number of
qualified providers of high technology programs of education for the
provision of such programs to covered individuals. Each such contract
shall provide for the conditions under which the Secretary may
terminate the contract with the provider and the procedures for
providing for the graduation of students who were enrolled in a program
provided by such provider in the case of such a termination.
``(2) A contract under this subsection shall provide that the
Secretary shall pay to a provider--
``(A) upon the enrollment of a covered individual in the
program, 25 percent of the cost of the tuition and other fees
for the program of education for the individual;
``(B) upon graduation of the individual from the program,
25 percent of such cost; and
``(C) 50 percent of such cost upon--
``(i) the successful employment of the covered
individual for a period--
``(I) of 180 days in the field of study of
the program; and
``(II) that begins not later than 180 days
following graduation of the covered individual
from the program;
``(ii) the employment of the individual by the
provider for a period of one year; or
``(iii) the enrollment of the individual in a
program of education to continue education in such
field of study.
``(3) For purposes of this section, a provider of a high technology
program of education is qualified if--
``(A) the provider employs instructors whom the Secretary
determines are experts in their respective fields in accordance
with paragraph (5);
``(B) the provider has successfully provided the high
technology program for at least one year;
``(C) the provider does not charge tuition and fees to a
covered individual who receives assistance under this section
to pursue such program that are higher than the tuition and
fees charged by such provider to another individual; and
``(D) the provider meets the approval criteria developed by
the Secretary under paragraph (4).
``(4)(A) The Secretary shall prescribe criteria for approving
providers of a high technology program of education under this section.
``(B) In developing such criteria, the Secretary may consult with
State approving agencies.
``(C) Such criteria are not required to meet the requirements of
section 3672 of this title.
``(D) Such criteria shall include the job placement rate, in the
field of study of a program of education, of covered individuals who
complete such program of education.
``(5) The Secretary shall determine whether instructors are experts
under paragraph (3)(A) based on evidence furnished to the Secretary by
the provider regarding the ability of the instructors to--
``(A) identify professions in need of new employees to
hire, tailor the programs to meet market needs, and identify
the employers likely to hire graduates;
``(B) effectively teach the skills offered to covered
individuals;
``(C) provide relevant industry experience in the fields of
programs offered to incoming covered individuals; and
``(D) demonstrate relevant industry experience in such
fields of programs.
``(6) In entering into contracts under this subsection, the
Secretary shall give preference to a provider of a high technology
program of education--
``(A) from which at least 70 percent of graduates find
full-time employment in the field of study of the program
during the 180-day period beginning on the date the student
graduates from the program; or
``(B) that offers tuition reimbursement for any student who
graduates from such a program and does not find employment
described in subparagraph (A).
``(d) Effect on Other Entitlement.--(1) If a covered individual
enrolled in a high technology program of education under this section
has remaining entitlement to educational assistance under chapter 30,
32, 33, 34, or 35 of this title, such entitlement shall be charged at
the rate of one month of such entitlement for each month of educational
assistance provided under this section.
``(2) If a covered individual enrolled in a high technology program
of education under this section does not have remaining entitlement to
educational assistance under chapter 30, 32, 33, 34, or 35 of this
title, any educational assistance provided to such individual under
this section shall be provided in addition to the entitlement that the
individual has used.
``(3) The Secretary may not consider enrollment in a high
technology program of education under this section to be assistance
under a provision of law referred to in section 3695 of this title.
``(4)(A) An application for enrollment in a high technology program
of education under this section shall include notice of the
requirements relating to use of entitlement under paragraphs (1) and
(2), including--
``(i) in the case of the enrollment of an individual
referred to under paragraph (1), the amount of entitlement that
is typically charged for such enrollment;
``(ii) an identification of any methods that may be
available for minimizing the amount of entitlement required for
such enrollment; and
``(iii) an element requiring applicants to acknowledge
receipt of the notice under this subparagraph.
``(B) If the Secretary approves the enrollment of a covered
individual in a high technology program of education under this
section, the Secretary shall deliver electronically to the individual
an award letter that provides notice of such approval and includes
specific information describing how paragraphs (1) and (2) will be
applied to the individual if the individual chooses to enroll in the
program.
``(e) Requirements for Educational Institutions.--(1) The Secretary
shall not approve the enrollment of any covered individual, not already
enrolled, in any high technology programs of education under this
section for any period during which the Secretary finds that more than
85 percent of the students enrolled in the program are having all or
part of their tuition, fees, or other charges paid to or for them by
the educational institution or by the Department of Veterans Affairs
under this title or under chapter 1606 or 1607 of title 10, except with
respect to tuition, fees, or other charges that are paid under a
payment plan at an educational institution that the Secretary
determines has a history of offering payment plans that are completed
not later than 180 days after the end of the applicable term, quarter,
or semester.
``(2) The Secretary may waive a requirement of paragraph (1) if the
Secretary determines, pursuant to regulations which the Secretary shall
prescribe, such waiver to be in the interest of the covered individual
and the Federal Government. Not later than 30 days after the Secretary
waives such a requirement, the Secretary shall submit to the Committees
on Veterans' Affairs of the Senate and the House of Representatives a
report regarding such waiver.
``(3)(A)(i) The Secretary shall establish and maintain a process by
which an educational institution may request a review of a
determination that the educational institution does not meet the
requirements of paragraph (1).
``(ii) The Secretary may consult with a State approving agency
regarding such process or such a review.
``(iii) Not later than 180 days after the Secretary establishes or
revises a process under this subparagraph, the Secretary shall submit
to the Committees on Veterans' Affairs of the Senate and the House of
Representatives a report regarding such process.
``(B) An educational institution that requests a review under
subparagraph (A)--
``(i) shall request the review not later than 30 days after
the start of the term, quarter, or semester for which the
determination described in subparagraph (A) applies; and
``(ii) may include any information that the educational
institution believes the Department should have taken into
account when making the determination, including with respect
to any mitigating circumstances.
``(f) Annual Reports.--Not later than one year after the date of
the enactment of this section, and annually thereafter until the
termination date specified in subsection (i), the Secretary shall
submit to the Committees on Veterans' Affairs of the Senate and the
House of Representatives a report on the operation of program under
this section during the year covered by the report. Each such report
shall include each of the following:
``(1) The number of covered individuals enrolled in the
program, disaggregated by type of educational institution,
during the year covered by the report.
``(2) The number of covered individuals who completed a
high technology program of education under the program during
the year covered by the report.
``(3) The average employment rate of covered individuals
who completed such a program of education during such year, as
of 180 days after the date of completion.
``(4) The average length of time between the completion of
such a program of education and employment.
``(5) The total number of covered individuals who completed
a program of education under the program and who, as of the
date of the submission of the report, are employed in a
position related to technology.
``(6) The average salary of a covered individual who
completed a program of education under the program and who is
employed in a position related to technology, in various
geographic areas determined by the Secretary.
``(7) The average salary of all individuals employed in
positions related to technology in the geographic areas
determined under subparagraph (F), and the difference, if any,
between such average salary and the average salary of a covered
individual who completed a program of education under the
program and who is employed in a position related to
technology.
``(8) The number of covered individuals who completed a
program of education under the program and who subsequently
enrolled in a second program of education under the program.
``(g) Collection of Information; Consultation.--(1) The Secretary
shall develop practices to use to collect information about covered
individuals and providers of high technology programs of education.
``(2) For the purpose of carrying out program under this section,
the Secretary may consult with providers of high technology programs of
education and may establish an advisory group made up of
representatives of such providers, private employers in the technology
field, and other relevant groups or entities, as the Secretary
determines necessary.
``(h) Definitions.--In this section:
``(1) The term `covered individual' means any of the
following:
``(A) A veteran whom the Secretary determines--
``(i) served an aggregate of at least 36
months on active duty in the Armed Forces
(including service on active duty in entry
level and skill training) and was discharged or
released therefrom under conditions other than
dishonorable; and
``(ii) has not attained the age of 62.
``(B) A member of the Armed Forces that the
Secretary determines will become a veteran described in
subparagraph (A) fewer than 180 days after the date of
such determination.
``(2) The term `high technology program of education' means
a program of education--
``(A) offered by a public or private educational
institution;
``(B) if offered by an institution of higher
learning, that is provided directly by such institution
rather than by an entity other than such institution
under a contract or other agreement;
``(C) that does not lead to a degree;
``(D) that has a term of not less than six and not
more than 28 weeks; and
``(E) that provides instruction in computer
programming, computer software, media application, data
processing, or information sciences.
``(i) Termination.--The Secretary may not provide educational
assistance under this section for a high technology program of
education that begins after September 30, 2026.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 3699B the following new item:
``3699C. High technology program.''.
(b) Effect on High Technology Pilot Program.--Section 116 of the
Harry W. Colmery Veterans Educational Assistance Act of 2017 (Public
Law 115-48; 38 U.S.C. 3001 note) is amended--
(1) by amending subsection (d) to read as follows:
``(d) Housing Stipend.--
``(1) In general.--Except as provided under paragraph (2),
the Secretary shall pay to each eligible veteran (not including
an individual described in the second sentence of subsection
(b)) who is enrolled in a high technology program of education
under the pilot program on a full-time or part-time basis a
monthly housing stipend equal to the product--
``(A) of--
``(i) in the case of a veteran pursuing
resident training, the monthly amount of the
basic allowance for housing payable under
section 403 of title 37, United States Code,
for a member with dependents in pay grade E-5
residing in the military housing area that
encompasses all or the majority portion of the
ZIP code area in which is located the campus of
the institution where the individual physically
participates in a majority of classes; or
``(ii) in the case of a veteran pursuing a
program of education through distance learning,
a monthly amount equal to 50 percent of the
national average of the monthly amount of the
basic allowance for housing payable under
section 403 of title 37, United States Code,
for a member with dependents in pay grade E-5,
multiplied by
``(B) the lesser of--
``(i) 1.0; or
``(ii) the number of course hours borne by
the individual in pursuit of the program of
education involved, divided by the minimum
number of course hours required for full-time
pursuit of such program of education, rounded
to the nearest multiple of 10.
``(2) Bar to dual eligibility.--No covered individual may
receive a housing stipend under this subsection for any month
if such individual is in receipt of a housing stipend under
chapter 33 ot title 38, United States Code, for that month.'';
(2) in subsection (g), by striking paragraph (6); and
(3) by striking subsection (h) and inserting the following
new subsection (h):
``(h) Termination.--The Secretary may not, under this section, pay
a provider for a high technology program of education that begins after
September 30, 2024.''.
(c) Approval of Certain High Technology Programs.--Section 3680A of
title 38, United States Code, is amended--
(1) in subsection (a), by striking paragraph (4) and
inserting the following:
``(4) Any independent study program except--
``(A) an independent study program (including such
a program taken over open circuit television) that--
``(i) is accredited by an accrediting
agency or association recognized by the
Secretary of Education under subpart 2 of part
H of title IV of the Higher Education Act of
1965 (20 U.S.C. 1099b);
``(ii) leads to--
``(I) a standard college degree;
``(II) a certificate that reflects
educational attainment offered by an
institution of higher learning; or
``(III) a certificate that reflects
graduation from a course of study
offered by--
``(aa) an area career and
technical education school (as
defined in subparagraphs (C)
and (D) of section 3(3) of the
Carl D. Perkins Career and
Technical Education Act of 2006
(20 U.S.C. 2302(3))) that
provides education at the
postsecondary level; or
``(bb) a postsecondary
vocational institution (as
defined in section 102(c) of
the Higher Education Act of
1965 (20 U.S.C. 1002(c))) that
provides education at the
postsecondary level; and
``(iii) in the case of a program described
in clause (ii)(III)--
``(I) provides training aligned
with the requirements of employers in
the State or local area where the
program is located, which may include
in-demand industry sectors or
occupations;
``(II) provides a student, upon
graduation from the program, with a
recognized postsecondary credential
that is recognized by employers in the
relevant industry, which may include a
credential recognized by industry or
sector partnerships in the State or
local area where the industry is
located; and
``(III) meets such content and
instructional standards as may be
required to comply with the criteria
under section 3676(c)(14) and (15) of
this title; or
``(B) an online high technology program of
education (as defined in subsection (h)(2) of section
3699C of this title)--
``(i) the provider of which has entered
into a contract with the Secretary under
subsection (c) of such section;
``(ii) that has been provided to covered
individuals (as defined in subsection (h)(1) of
such section) under such contract for a period
of at least five years;
``(iii) regarding which the Secretary has
determined that the average employment rate of
covered individuals who graduated from such
program of education is 65 percent or higher
for the year preceding such determination; and
``(iv) that satisfies the requirements of
subsection (e) of such section.''; and
(2) in subsection (d), by adding at the end the following:
``(8) Paragraph (1) shall not apply to the enrollment of a veteran
in an online high technology program described in subsection
(a)(4)(B).''.
(d) Effective Date.--The amendments made by subsections (a) and (c)
shall take effect on October 1, 2024.
SEC. 213. NOTICE OF CHANGES TO DEPARTMENT OF VETERANS AFFAIRS POLICIES
AND GUIDANCE AFFECTING THE EDUCATIONAL ASSISTANCE
PROGRAMS OF THE DEPARTMENT.
(a) In General.--Subchapter III of chapter 36 of title 38, United
States Code, as amended by sections 210 and 212, is further amended by
adding at the end the following new section:
``Sec. 3699D. Notice of changes to policies and guidance relating to
educational assistance programs
``In the case of any change to any policy or guidance provided by
the Secretary that relates to any educational assistance program of the
Department, the Secretary may not implement the change before the date
that is 90 days after the date on which the Secretary makes available
to students, educational institutions, and the Committees on Veterans'
Affairs of the Senate and House of Representatives notice of, and
justification for, the change.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
3699B the following new item:
``3699D. Notice of changes to policies and guidance relating to
educational assistance programs.''.
(c) Effective Date.--Section 3699D of title 38, United States Code,
as added by subsection (a), shall take effect on the date of the
enactment of this Act and apply with respect to a rule making on or
after August 1, 2024.
SEC. 214. PAYMENT OF VA EDUCATIONAL ASSISTANCE VIA ELECTRONIC FUND
TRANSFER TO A FOREIGN INSTITUTION OF HIGHER EDUCATION.
Not later than 90 days after the date of the enactment of this Act,
the Secretary of Veterans Affairs shall update the payment system of
the Department of Veterans Affairs to allow for electronic fund
transfer of educational assistance, administered by the Secretary, to a
foreign institution of higher education that--
(1) provides an approved course of education to an eligible
recipient of such assistance; and
(2) does not have--
(A) an employer identification number; or
(B) an account with a domestic bank.
SEC. 215. IMPROVING TRANSPARENCY AND ACCOUNTABILITY OF EDUCATIONAL
INSTITUTIONS FOR PURPOSES OF VETERANS EDUCATIONAL
ASSISTANCE.
(a) Requirement Relating to G.I. Bill Comparison Tool.--
(1) Requirement to maintain tool.--The Secretary of
Veterans Affairs shall maintain the G.I. Bill Comparison Tool
that was established pursuant to Executive Order 13607 (77 Fed.
Reg. 25861; relating to establishing principles of excellence
for educational institutions serving service members, veterans,
spouses, and other family members) and in effect on the day
before the date of enactment of this Act, or a successor tool,
to provide relevant and timely information about programs of
education approved under chapter 36 of title 38, United States
Code, and the educational institutions that offer such
programs.
(2) Data retention.--The Secretary shall ensure that
historical data that is reported via the tool maintained under
paragraph (1) remains easily and prominently accessible on the
benefits.va.gov website, or a successor website, for a period
of not less than six years from the date of initial
publication.
(b) Providing Timely and Relevant Education Information to
Veterans, Members of the Armed Forces, and Other Individuals.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Secretary of Veterans Affairs,
in consultation with the Secretary of Education, the Secretary
of the Treasury, and the heads of other relevant Federal
agencies, shall make such changes to the tool maintained under
subsection (a) as the Secretary of Veterans Affairs determines
appropriate to ensure that such tool is an effective and
efficient method for providing information pursuant to section
3698(b)(5) of title 38, United States Code.
(2) Memorandum of understanding required.--Not later than
two years after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall seek to enter into a
memorandum of understanding with the Secretary of Education and
the heads other relevant Federal agencies, as the Secretary of
Veterans Affairs determines appropriate, to obtain information
on outcomes with respect to individuals who are entitled to
educational assistance under the laws administered by the
Secretary of Veterans Affairs and who are attending educational
institutions. Such memorandum of understanding may include data
sharing or computer matching agreements.
(3) Modification of scope of comprehensive policy on
providing education information.--Section 3698 of title 38,
United States Code, is amended--
(A) in subsection (a), by striking ``veterans and
members of the Armed Forces'' and inserting
``individuals entitled to educational assistance under
laws administered by the Secretary of Veterans
Affairs''; and
(B) in subsection (b)(5)--
(i) by striking ``veterans and members of
the Armed Forces'' and inserting ``individuals
described in subsection (a)''; and
(ii) by striking ``the veteran or member''
and inserting ``the individual''.
(4) G.I. bill comparison tool required disclosures.--
Paragraph (1) of subsection (c) of such section is amended--
(A) by striking subparagraph (B) and inserting the
following:
``(B) for each individual described in subsection (a)
seeking information provided under subsection (b)(5), the name
of each Federal student aid program, and a description of each
such program, from which the individual may receive educational
assistance;'';
(B) in subparagraph (C)--
(i) in clause (i), by inserting ``and a
definition of each type of institution'' before
the semicolon;
(ii) in clause (iv), by inserting ``and if
so, which programs'' before the semicolon;
(iii) by striking clause (v) and inserting
the following:
``(v) the average annual cost and the total cost to
earn an associate's degree and a bachelor's degree,
with available cost information on any other degree or
credential the institution awards;'';
(iv) in clause (vi), by inserting before
the semicolon the following: ``disaggregated
by--
``(I) the type of beneficiary of
educational assistance;
``(II) individuals who received a
credential and individuals who did not; and
``(II) individuals using educational
assistance under laws administered by the
Secretary and individuals who are not'';
(v) in clause (xiv), by striking ``and'' at
the end;
(vi) in clause (xv), by striking the period
at the end and inserting a semicolon; and
(vii) by adding at the end the following
new clauses:
``(xvi) the number of veterans or members who
completed covered education at the institution leading
to--
``(I) a degree, disaggregated by type of
program, including--
``(aa) an associate degree;
``(bb) a bachelor's degree; and
``(cc) a postbaccalaureate degree;
and
``(II) a certificate or professional
license, disaggregated by type of certificate
or professional license;
``(xvii) programs available and the average time
for completion of each program;
``(xviii) employment rate and median income of
graduates of the institution in general two and five
years after graduation, disaggregated by--
``(I) specific program; and
``(II) individuals using educational
assistance under laws administered by the
Secretary and individuals who are not; and
``(xix) the number of individuals using educational
assistance under laws administered by the Secretary who
are enrolled in the both the institution and specific
program per year.''.
(5) Clarity and anonymity of information provided.--
Paragraph (2) of such subsection is amended--
(A) by inserting ``(A)'' before ``To the extent'';
and
(B) by adding at the end the following new
subparagraph:
``(B) The Secretary shall ensure that information provided pursuant
to subsection (b)(5) is provided in a manner that is easy for, and
accessible to, individuals described in subsection (a).
``(C) In providing information pursuant to subsection (b)(5), the
Secretary shall maintain the anonymity of individuals described in
subsection (a) and, to the extent that a portion of any data would
undermine such anonymity, ensure that such data is not made available
pursuant to such subsection.''.
(c) Improvements for Student Feedback.--
(1) In general.--Subsection (b)(2) of such section is
amended--
(A) by amending subparagraph (A) to read as
follows:
``(A) provides institutions of higher learning--
``(i) up to 30 days to review and respond
to feedback from individuals described in
subsection (a) and address issues regarding the
feedback before the feedback is published; and
``(I) if an institution of higher learning
contests the accuracy of the feedback, the
opportunity to challenge the inclusion of such
data with an official appointed by the
Secretary;'';
(B) in subparagraph (B), by striking ``and'' at the
end;
(C) in subparagraph (C), by striking ``that
conforms with criteria for relevancy that the Secretary
shall determine.'' and inserting ``, and responses from
institutions of higher learning to such feedback, that
conform with criteria for relevancy that the Secretary
shall determine;''; and
(D) by adding at the end the following new
subparagraphs:
``(D) for each institution of higher learning that
is approved under this chapter, retains, maintains, and
publishes all of such feedback for not less than six
years; and
``(E) is easily accessible to individuals described
in subsection (a) and to the general public.''.
(2) Accessibility from g.i. bill comparison tool.--The
Secretary shall ensure that--
(A) the feedback tracked and published under
subsection (b)(2) of such section, as amended by
paragraph (1), is prominently displayed in the tool
maintained under subsection (a) of this section; and
(B) when such tool displays information for an
institution of higher learning, the applicable feedback
is also displayed for such institution of higher
learning.
(d) Training for Provision of Education Counseling Services.--
(1) In general.--Not less than one year after the date of
the enactment of this Act, the Secretary shall ensure that
personnel employed by the Department of Veteran Affairs, or a
contractor of the Department, to provide education benefits
counseling, vocational or transition assistance, or similar
functions, including employees or contractors of the Department
who provide such counseling or assistance as part of the
Transition Assistance Program, are trained on how--
(A) to use properly the tool maintained under
subsection (a); and
(B) to provide appropriate educational counseling
services to individuals described in section 3698(a) of
such title, as amended by subsection (b)(3)(A).
(2) Transition assistance program defined.--In this
subsection, the term ``Transition Assistance Program'' means
the program of counseling, information, and services under
section 1142 of title 10, United States Code.
Subtitle B--Employment and Training
SEC. 221. IMPROVEMENTS TO REEMPLOYMENT RIGHTS OF MEMBERS OF THE ARMED
FORCES.
(a) USERRA Purposes.--Section 4301(a)(1) of title 38, United States
Code, is amended by striking ``encourage noncareer service in the
uniformed services'' and inserting ``encourage service in the uniformed
services''.
(b) Prohibition of Retaliation.--Subsection (b) of section 4311 of
title 38, United States Code, is amended by inserting ``or other
retaliatory action'' after ``employment action''.
(c) Expansion of Injunctive Relief.--Subsection (e) of section 4323
of such title is amended--
(1) by striking ``The court shall use'' and inserting ``(1)
The court shall use''; and
(2) by adding at the end the following new paragraphs:
``(2) A person bringing an action to enforce a provision of this
chapter pursuant to subsection (a) shall be entitled to an injunction
under paragraph (1) if such person demonstrates--
``(A) a violation--
``(i) of the provisions of this chapter; or
``(ii) of the provisions of this chapter is
threatened or is imminent;
``(B) the harm to the person outweighs the injury to the
employer;
``(C) a likelihood of success on the merits of such action;
and
``(D) awarding such relief is in the public interest.
``(3) The court may not deny a motion for injunctive relief on the
basis that a party bringing an action to enforce a provision of this
chapter may be awarded wages unearned due to an unlawful termination or
denial of employment at the conclusion of such action.''.
(d) Damages Against a State or Private Employer.--Section 4323 of
such title is further amended, in paragraph (1) of subsection (d), by
striking subparagraph (C) and inserting the following new
subparagraphs:
``(C) The court may require the employer to pay the person
the amount referred to in subparagraph (B) and interest on such
amount, calculated at a rate of 3 percent per year.
``(D) The court may require the employer to pay the person
the greater of $50,000 or the amount equal to the amounts
referred to in subparagraphs (B) and (C) as liquidated damages,
if the court determines that the employer knowingly failed to
comply with the provisions of this chapter.''.
(e) Mandatory Attorney Fees Award in Successful Actions for
Reemployment.--
(1) MSPB actions.--Paragraph (4) of subsection (c) of
section 4324 of such title is amended--
(A) by striking ``may, in its discretion,'' and
inserting ``shall''; and
(B) by adding at the end the following new
sentence: ``The Board may, in its discretion, award
reasonable attorney fees in a case settled before the
issuance of an order if the person can demonstrate that
significant attorney fees were incurred and that
justice requires such an award.''.
(2) Federal circuit actions.--Subsection (d) of such
section is amended by adding at the end the following new
paragraph:
``(3) In such Federal Circuit proceeding, the court shall award
such person reasonable attorney fees, expert witness fees, and other
litigation expenses if such person--
``(A) prevails in such Federal Circuit proceeding; and
``(B) is not represented by the Special Counsel in such
Federal Circuit proceeding.''.
(3) Actions against a state or private employer.--Paragraph
(2) of section 4323(h) of such title is amended--
(A) by striking ``subsection (a)(2)'' and inserting
``subsection (a)(3)''; and
(B) by striking ``the court may award any such
person who prevails in such action or proceeding
reasonable attorney fees'' and inserting ``the court
shall award any such person who prevails in such action
or proceeding reasonable attorney fees''.
(f) GAO Review and Report on USERRA.--
(1) Review.--The Comptroller General of the United States
shall review the methods through which the Secretary of Labor,
acting through the Veterans' Employment and Training Service,
processes actions for relief under chapter 43 of title 38,
United States Code.
(2) Elements.--Not later than one year after the date of
the enactment of this Act, the Comptroller General shall submit
to the Committees on Veterans' Affairs of the House of
Representatives and the Senate a report that includes--
(A) the findings of the review required under
paragraph (1);
(B) an identification of the number of actions for
relief under chapter 43 of title 38, United States
Code, initiated during the period covered by the
report, disaggregated by size of employer and
geographic region;
(C) an identification of the number of such actions
for relief that were erroneously dismissed, as
determined by the Comptroller General;
(D) an identification of the number of such actions
for relief that were referred to the Department of
Justice; and
(E) an assessment of trends, if any, in such
actions for relief initiated during such period.
(g) GAO Review of Protections for Members of the Uniformed Services
by Federal Intelligence Agencies.--
(1) In general.--Not later than one year after the date of
the enactment of this Act, the Comptroller General of the
United States shall submit to the appropriate congressional
committees a report on the processes and procedures adopted and
used by the intelligence community to provide the protections
for members of the uniformed services otherwise established
under chapter 43 of title 38, United States Code.
(2) Definitions.--In this subsection:
(A) The term ``appropriate congressional
committees'' means the Committees on Veterans' Affairs
of the House of Representatives and Senate, the
Permanent Select Committee on Intelligence of the House
of Representatives, and the Select Committee on
Intelligence of the Senate.
(B) The term ``intelligence community'' has the
meaning given such term in section 3(4) of the National
Security Act of 1947 (50 U.S.C. 3003(4)).
SEC. 222. REVIEW OF INVESTIGATIONS MANUAL OF VETERANS' EMPLOYMENT AND
TRAINING SERVICE.
(a) In General.--Not later than one year after the date of the
enactment of this Act, and once every two years thereafter for the
period of five years beginning on such date, the Secretary of Labor,
shall review the manual of the Department of Labor titled ``Veterans'
Employment and Training Service Investigations Manual: USERRA, VEOA,
and VP'' (or a successor manual) and make such revisions to such manual
as the Secretary determines appropriate.
(b) Report.--Not later than 90 days after any date on which the
Secretary completes a review required under subsection (a), the
Secretary shall submit to the Committees on Veterans' Affairs of the
House of Representatives and the Senate--
(1) a report that includes a description of any revision to
such manual made pursuant to such review; and
(2) a copy of the entire such manual which--
(A) shall be provided to the Chairman and Ranking
Member of each such committee; and
(B) may contain a separate addendum for portions of
the manual that contain law enforcement sensitive
materials.
SEC. 223. WARRIOR TRAINING ADVANCEMENT COURSE.
(a) Reporting on the Warrior Training Advancement Course.--
(1) Reports required.--
(A) Initial report.--Not later than six months
after the date of the enactment of this Act, the
Secretary of Veterans Affairs shall submit to the
Committees on Veterans' Affairs of the Senate and the
House of Representatives a report on WARTAC.
(B) Annual report.--One year after the submission
of the report required under paragraph subparagraph (A)
and annually thereafter, the Secretary shall submit to
such Committees a report that contains the elements
under subparagraphs (A) and (C) of paragraph (2) with
regards to the preceding year.
(2) Elements.--Except as provided in paragraph (1)(B), the
reports under this subsection shall include the following
elements:
(A) Best practices.--With regards to best practices
of WARTAC--
(i) how many covered members have applied
to participate in WARTAC;
(ii) how many covered members have
participated in WARTAC;
(iii) how the Secretary provides training
to covered members during TAP;
(iv) how many covered members have
completed WARTAC; and
(v) any other information the Secretary
determines appropriate.
(B) Cost savings.--With regards to cost savings of
WARTAC--
(i) how much money the Secretary determines
WARTAC saves the United States each fiscal
year;
(ii) how much money the Secretary
determines WARTAC has saved the United States
since its establishment; and
(iii) the determination of the Secretary
whether other Federal agencies may save money
by establishing a program similar to WARTAC.
(C) Hiring.--With regards to hiring covered members
who complete WARTAC--
(i) how the Secretary identifies positions
in the Department of Veterans Affairs for which
such covered members may qualify;
(ii) the grades of such positions on the
General Schedule under section 5332 of title 5,
United States Code; and
(iii) how many such covered members the
Secretary has hired to such positions.
(3) Distribution.--Not later than 30 days after submitting
the report under paragraph (1)(A), the Secretary of Veterans
Affairs shall transmit a copy of the report under this section
to the head of each Federal agency.
(4) Definitions.--In this subsection:
(A) The term ``covered member'' means members of
the Armed Forces participating in TAP.
(B) The term ``TAP'' means the Transition
Assistance Program under sections 1142 and 1144 of
title 10, United States Code.
(C) The term ``WARTAC'' means the Warrior Training
Advancement Course of the Veterans Benefit
Administration, in which the Secretary provides
training to covered members so such covered members may
qualify for certain employment in the Veterans Benefit
Administration.
(b) Pilot Program To Employ Veterans in Positions Relating to
Conservation and Resource Management Activities.--
(1) Best practices for other departments.--The Assistant
Secretary of Labor for Veterans' Employment and Training, in
consultation with the Secretary of Veterans Affairs, shall
establish guidelines containing best practices for departments
and agencies of the Federal Government that carry out programs
to employ veterans who are transitioning from service in the
Armed Forces. Such guidelines shall include the findings of the
initial report required under subsection (a)(1).
(2) Pilot program.--
(A) Establishment.--The Secretary of the Interior,
in consultation with the Assistant Secretary of Labor
for Veterans' Employment and Training and the Secretary
of Veterans Affairs, shall establish a pilot program
under which veterans are employed by the Federal
Government in positions that relate to the conservation
and resource management activities of the Department of
the Interior.
(B) Commencement.--The Secretary of the Interior
shall commence the pilot program at least 60, but not
more than 180, days after the date of the submission of
the report required under subsection (a)(1)(A).
(C) Positions.--The Secretary of the Interior
shall--
(i) identify vacant positions in the
Department of the Interior that are appropriate
to fill using the pilot program; and
(ii) to the extent practicable, fill such
positions using the pilot program.
(D) Application of civil service laws.--A veteran
employed under the pilot program shall be treated as an
employee as defined by section 2105 of title 5, United
States Code.
(E) Briefings and report.--
(i) Initial briefing.--Not later than 60
days after the date of the submission of the
report required under subsection (a)(1)(A), the
Secretary of the Interior and the Assistant
Secretary of Labor for Veterans' Employment and
Training shall jointly provide to the
appropriate congressional committees a briefing
on the pilot program under this subsection,
which shall include a description of how the
pilot program will be carried out in a manner
to reduce the unemployment of veterans.
(ii) Implementation briefing.--Not later
than one year after the date on which the pilot
program under this paragraph commences, the
Secretary of the Interior and the Assistant
Secretary of Labor for Veterans' Employment and
Training shall jointly provide to the
appropriate congressional committees a briefing
on the implementation of the pilot program.
(iii) Final report.--Not later than 30 days
after the date on which the pilot program under
this paragraph is completed, the Secretary of
the Interior and the Assistant Secretary of
Labor for Veterans' Employment and Training
shall jointly submit to the appropriate
congressional committees a report on the pilot
program that includes the following:
(I) The number of veterans who
applied to participate in the pilot
program.
(II) The number of such veterans
employed under the pilot program.
(III) The number of veterans
identified in subclause (II) who
transitioned to full-time positions
with the Federal Government after
participating in the pilot program.
(IV) Recommendations with respect
to extending the pilot or making the
program permanent.
(V) Any other information the
Secretary and the Assistant Secretary
determine appropriate with respect to
measuring the effectiveness of the
pilot program.
(F) Duration.--The authority to carry out the pilot
program under this paragraph shall terminate on the
date that is two years after the date on which the
pilot program commences.
(3) Appropriate congressional committees defined.--In this
subsection, the term ``appropriate congressional committees''
means--
(A) the Committee on Veterans' Affairs and the
Committee on Natural Resources of the House of
Representatives; and
(B) the Committee on Veterans' Affairs and the
Committee on Energy and Natural Resources of the
Senate.
Subtitle C--Home Loans
SEC. 231. IMPROVEMENTS TO PROGRAM FOR DIRECT HOUSING LOANS MADE TO
NATIVE AMERICAN VETERANS BY THE SECRETARY OF VETERANS
AFFAIRS.
(a) General Authorities and Requirements.--
(1) Direct housing loans to native american veterans.--
Section 3762(a) of title 38, United States Code, is amended to
read as follows:
``(a) The Secretary may make a direct housing loan to a Native
American veteran under this subchapter if the Secretary ensures the
following:
``(1) That each Native American veteran to whom the
Secretary makes a direct housing loan under this subchapter--
``(A) holds, possesses, or purchases using the
proceeds of the loan a meaningful interest in a lot or
dwelling (or both) that is located on trust land; and
``(B) will purchase, construct, or improve (as the
case may be) a dwelling on the lot using the proceeds
of the loan.
``(2) That each such Native American veteran will convey to
the Secretary by an appropriate instrument the interest
referred to in paragraph (1)(A) as security for a direct
housing loan under this subchapter.
``(3) That the Secretary, including the Secretary's
employees or agents, may enter upon the trust land for the
purposes of carrying out such actions as the Secretary
determines are necessary, including--
``(A) to evaluate the advisability of the loan;
``(B) to monitor any purchase, construction, or
improvements carried out using the proceeds of the
loan; and
``(C) to manage any servicing or post-foreclosure
activities, including acquisition, property
inspections, and property management.
``(4) That there are established standards and procedures
that apply to the foreclosure of the interest conveyed by a
Native American veteran pursuant to paragraph (2), including--
``(A) procedures for foreclosing the interest; and
``(B) procedures for the resale of the lot or
dwelling (or both) purchased, constructed, or improved
using the proceeds of the loan.
``(5) That the loan is made in a responsible and prudent
manner, subject to standards and procedures as are necessary
for the reasonable protection of the financial interests of the
United States.''.
(2) Memorandums of understanding, agreements, and
determinations.--Section 3762(b) of such title is amended to
read as follows:
``(b)(1) To carry out the purpose of subsection (a), the Secretary
may--
``(A) enter into a memorandum of understanding with a
tribal organization, other entity, or individual;
``(B) rely on agreements or determinations of other Federal
agencies to guarantee, insure, or make loans on trust land; and
``(C) enter into other agreements or take such other
actions as the Secretary determines necessary.
``(2) If the Secretary determines that the requirements under
subsection (a) are not being enforced by a tribal organization, other
entity, or individual that is a party to any memorandum of
understanding, agreement, or determination described in paragraph (1),
the Secretary may cease making new direct housing loans to Native
American veterans under this subchapter within the area of the
authority of the tribal organization, other entity, or individual (as
the case may be).''.
(b) Direct Loans to Native American Veterans To Refinance Existing
Mortgage Loans.--Section 3762(h) of such title is amended to read as
follows:
``(h) The Secretary may make direct loans to Native American
veterans in order to enable such veterans to refinance existing
mortgage loans for any of the following purposes:
``(1) To refinance an existing loan made under this
section, if the loan--
``(A) meets the requirements set forth in
subparagraphs (B), (C), and (E) of paragraph (1) of
section 3710(e) of this title;
``(B) will bear an interest rate at least one
percentage point less than the interest rate borne by
the loan being refinanced; and
``(C) complies with paragraphs (2) and (3) of
section 3710(e) of this title, except that for the
purposes of this subsection the reference to subsection
(a)(8) of section 3710 of this title in such paragraphs
(2) and (3) shall be deemed to be a reference to this
subsection.
``(2) To refinance an existing mortgage loan not made under
this section on a dwelling owned and occupied by the veteran as
the veteran's home, if all of the following requirements are
met:
``(A) The loan will be secured by the same dwelling
as was the loan being refinanced.
``(B) The loan will provide the veteran with a net
tangible benefit.
``(C) The nature and condition of the property is
such as to be suitable for dwelling purposes.
``(D) The amount of the loan does not exceed either
of the following:
``(i) 100 percent of the reasonable value
of the dwelling, with such reasonable value
determined under the procedures established by
the Secretary under subsection (d)(2).
``(ii) An amount equal to the sum of the
balance of the loan being refinanced and such
closing costs (including any discount points)
as may be authorized by the Secretary to be
included in the loan.
``(E) Notwithstanding subparagraph (D), if a loan
is made for both the purpose of this paragraph and to
make energy efficiency improvements, the loan must not
exceed either of the following:
``(i) 100 percent of the reasonable value
of the dwelling as improved for energy
efficiency, with such reasonable value
determined under the procedures established by
the Secretary under subsection (d)(2).
``(ii) The amount referred to under
subparagraph (D)(ii), plus the applicable
amount specified under section 3710(d)(2) of
this title.
``(F) The loan meets all other requirements the
Secretary may establish under this subchapter.
``(G) The existing mortgage being refinanced is a
first lien on the property and secured of record.
``(3) To refinance an existing mortgage loan to repair,
alter, or improve a dwelling owned by the veteran and occupied
by the veteran as the veteran's home, if all of the following
requirements are met:
``(A) The loan will be secured by the same dwelling
as was the loan being refinanced.
``(B) The nature and condition of the property is
such as to be suitable for dwelling purposes, and the
repair, alteration, or improvement substantially
protects or improves the basic livability or utility of
such property.
``(C) The amount of the loan, including the costs
of repairs, alterations, and improvements, does not
exceed either of the following:
``(i) 100 percent of the reasonable value
of the dwelling as repaired, altered, or
improved, with such reasonable value determined
under the procedures established by the
Secretary under subsection (d)(2).
``(ii) An amount equal to the sum of--
``(I) the balance of the loan being
refinanced;
``(II) the actual cost of repairs,
alterations, or improvements; and
``(III) such closing costs
(including any discount points) as may
be authorized by the Secretary to be
included in the loan.
``(D) The loan meets all other requirements the
Secretary may establish under this subchapter.
``(E) The existing mortgage loan being refinanced
is a first lien on the property and secured of
record.''.
(c) Expansion of Outreach Program on Availability of Direct Housing
Loans for Native American Veterans.--Section 3762(i)(2) of such title
is amended by adding at the end the following new subparagraph:
``(G) Pursuant to subsection (g)(4), assisting Native
American veterans in qualifying for mortgage financing by--
``(i) partnering with local service providers, such
as tribal organizations, tribally designated housing
entities, Native community development financial
institutions, and nonprofit organizations, for
conducting outreach, homebuyer education, housing
counseling, and post-purchase education; and
``(ii) providing other technical assistance as
needed.
``(H) Attending conferences and conventions conducted by
the network of Native community development financial
institutions and other Native American homeownership
organizations to provide information and training to Native
community development financial institutions about the
availability of the relending program under section 3762A of
this title.''.
(d) Adequate Personnel.--Section 3762 of such title is amended by
adding at the end the following new subsection:
``(k) The Secretary shall assign a sufficient number of personnel
of the Department dedicated to carrying out the authority of the
Secretary under this subchapter, including construction and valuation
specialists to assist with issues unique to new construction and
renovations on trust land.''.
(e) Definitions.--Section 3765 of such title is amended--
(1) in paragraph (1)--
(A) by amending subparagraph (C) to read as
follows:
``(C) is located in the State of Alaska within a
region established under section 7(a) of the Alaska
Native Claims Settlement Act (43 U.S.C. 1606(a));'';
(B) in subparagraph (D), by striking the period at
the end and inserting a semicolon; and
(C) by adding at the end the following new
subparagraphs:
``(E) is defined by the Secretary of the Interior
and recognized by the United States as land over which
an Indian Tribe has governmental dominion; or
``(F) is on any land that the Secretary determines
is provided to Native American veterans because of
their status as Native Americans.''; and
(2) by adding at the end the following new paragraphs:
``(6) The term `community development financial
institution' has the meaning given that term in section 103 of
the Community Development Banking and Financial Institutions
Act of 1994 (12 U.S.C. 4702).
``(7) The term `Indian Tribe' means any Indian tribe, band,
nation, or other organized group or community, including any
Alaska Native village or regional or village corporation as
defined in or established pursuant to the Alaska Native Claims
Settlement Act (43 U.S.C. 1601 et seq.), which is recognized as
eligible for the special programs and services provided by the
United States to Indians because of their status as Indians.
``(8) The term `Native community development financial
institution' means any entity--
``(A) that has been certified as a community
development financial institution by the Secretary of
the Treasury;
``(B) that is not less than 51 percent owned or
controlled by Native Americans; and
``(C) for which not less than 51 percent of the
activities of the entity serve Native Americans.
``(9) The term `net tangible benefit' shall have such
meaning as the Secretary determines appropriate, but shall
include the refinance of an interim construction loan.
``(10) The term `other technical assistance' means services
to assist a Native American veteran to navigate the steps
necessary for securing a mortgage loan on trust land, including
pre-development activities related to utilities, identifying
appropriate residential construction services, and obtaining
lease clearances and title status reports from the applicable
tribal organization or the Bureau of Indian Affairs.
``(11) The term `tribally designated housing entity' has
the meaning given that term in section 4 of the Native American
Housing Assistance and Self-Determination Act of 1996 (25
U.S.C. 4103).''.
(f) Interest Rate Reduction Financing Loan.--Section 3729(b)(4)(F)
of such title is amended by striking ``3762(h)'' and inserting
``3762(h)(1)''.
(g) Regulations.--Section 3761 of such title is amended by adding
at the end the following new subsection:
``(c) The Secretary shall prescribe such regulations as may be
necessary to carry out this subchapter.''.
SEC. 232. NATIVE COMMUNITY DEVELOPMENT FINANCIAL INSTITUTION RELENDING
PROGRAM.
(a) In General.--Subchapter V of chapter 37 of title 38, United
States Code, is amended by inserting after section 3762 the following
new section:
``Sec. 3762A. Native community development financial institution
relending program
``(a) Purpose.--The Secretary may make a loan to a Native community
development financial institution for the purpose of allowing the
institution to relend loan amounts to qualified Native American
veterans, subject to the requirements of this section.
``(b) Standards.--(1) The Secretary shall establish standards to be
used in evaluating whether to make a loan to a Native community
development financial institution under this section.
``(2) In establishing standards under paragraph (1), the Secretary
shall ensure that a Native community development financial
institution--
``(A) is able to originate and service loans for single-
family homes;
``(B) is able to operate the relending program in a manner
consistent with the mission of the Department to serve
veterans; and
``(C) uses loan amounts received under this section only
for the purpose of relending, as described in subsection (c),
to Native American veterans.
``(c) Relending Requirements.--(1) A Native community development
financial institution that receives a loan under this section shall use
the loan amounts to make loans to Native American veterans residing on
trust land.
``(2) A loan to a Native American veteran made by a Native
community development financial institution under paragraph (1) shall--
``(A) be limited either to the purpose of purchase,
construction, or improvement of a dwelling located on trust
land or to the refinance of an existing mortgage loan for a
dwelling on trust land, consistent with the requirements of
section 3762(h) of this title; and
``(B) comply with such terms and conditions as the
Secretary determines are necessary to protect against predatory
lending, including the interest rate charged on a loan to a
Native American veteran.
``(d) Repayment.--A loan made to a Native community development
financial institution under this section shall--
``(1) be payable to the Secretary upon such terms and
conditions as are prescribed in regulations pursuant to this
subchapter; and
``(2) bear interest at a rate of one percent.
``(e) Oversight.--Subject to notice and opportunity for a hearing,
whenever the Secretary finds with respect to loans made under
subsection (a) or (c) that any Native community development financial
institution has failed to maintain adequate loan accounting records, to
demonstrate proper ability to service loans adequately, or to exercise
proper credit judgment, or that such Native community development
financial institution has willfully or negligently engaged in practices
otherwise detrimental to the interest of veterans or of the Government,
the Secretary may take such actions as the Secretary determines
necessary to protect veterans or the Government, such as requiring
immediate repayment of any loans made under subsection (a) and the
assignment to the Secretary of loans made under subsection (c).
``(f) Sunset.--The Secretary may not make a loan under this section
after September 30, 2026.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 37 of such title is amended by inserting after the item
relating to section 3762 the following new item:
``3762A. Native community development financial institution relending
program.''.
(c) Native American Veteran Housing Loan Program Account.--Section
3763 of such title is amended by adding at the end the following new
subsection:
``(c) Of amounts available in the Account, the Secretary may use
for loans made under section 3762A of this title--
``(1) in fiscal year 2024, not more than $5,000,000; and
``(2) in any fiscal year after fiscal year 2024, an amount
determined necessary by the Secretary to meet the demand for
such loans.''.
TITLE III--DISABILITY AND MEMORIAL AFFAIRS MATTERS
SEC. 301. BURIAL ALLOWANCE FOR CERTAIN VETERANS WHO DIE AT HOME WHILE
IN RECEIPT OF HOSPICE CARE FURNISHED BY DEPARTMENT OF
VETERANS AFFAIRS.
(a) In General.--The Secretary of Veterans Affairs shall treat a
veteran described in subsection (b) as a veteran described in
subparagraph (A) of section 2303(a)(2) of title 38, United States Code.
(b) Veteran Described.--A veteran described in this subsection is a
veteran who dies in a home or other setting at which the deceased
veteran was, at the time of death, receiving hospice care pursuant to
section 1717(a) of such title if such care was directly preceded by the
Secretary furnishing to the veteran hospital care or nursing home care
described in clause (ii) of such subparagraph.
(c) Effective Date; Applicability.--This section shall apply with
respect to deaths that occur--
(1) on or after the date that is 180 days after the date of
the enactment of this Act; and
(2) before October 1, 2026.
SEC. 302. AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO AWARD GRANTS
TO STATES AND INDIAN TRIBES TO IMPROVE OUTREACH TO
VETERANS.
(a) In General.--Chapter 63 of title 38, United States Code, is
amended--
(1) by redesignating sections 6307 and 6308 as sections
6308 and 6309, respectively; and
(2) by inserting after section 6306 the following new
section 6307:
``Sec. 6307. Grants to States and Indian Tribes to improve outreach to
veterans
``(a) Purpose.--It is the purpose of this section to provide for
assistance by the Secretary to States and Indian Tribes to carry out
programs that improve covered outreach and assistance to veterans and
the spouses, children, and parents of veterans, to ensure that such
individuals are fully informed about, and assisted in applying for, any
veterans and veterans-related benefits and programs (including veterans
programs of a State or Indian Tribe) for which they may be eligible and
facilitate opportunities for such individuals to receive competent,
qualified services in the preparation, presentation and prosecution of
veterans benefits claims.
``(b) Authority.--The Secretary may award grants to States and
Indian Tribes--
``(1) to carry out, coordinate, improve, or otherwise
enhance--
``(A) covered outreach activities; or
``(B) activities to assist in the development and
submittal of claims for veterans and veterans-related
benefits; or
``(2) to increase the number of county or Tribal veterans
service officers serving in the State by hiring new, additional
such officers.
``(c) Application.--(1) To be eligible for a grant under this
section, a State or Indian Tribe shall submit to the Secretary an
application therefor at such time, in such manner, and containing such
information as the Secretary may require.
``(2) Each application submitted under paragraph (1) shall include
the following:
``(A) A detailed plan for the use of the grant.
``(B) A description of the programs through which the State
or Indian Tribe will meet the outcome measures developed by the
Secretary under subsection (j).
``(C) A description of how the State or Indian Tribe will
distribute grant amounts equitably among counties or Tribal
lands with varying levels of urbanization.
``(D) A plan for how the grant will be used to meet the
unique needs of American Indian veterans, Alaska Native
veterans, or Native Hawaiian veterans, elderly veterans, and
veterans from other underserved communities.
``(d) Distribution.--The Secretary shall seek to ensure that grants
awarded under this section are equitably distributed among States and
Indian Tribes with varying levels of urbanization.
``(e) Set-Aside.--Of the amounts authorized to be appropriated or
otherwise made available for grants under this section for any fiscal
year, the Secretary shall ensure that not less than five percent is
used to make grants to Indian Tribes.
``(f) Priority.--The Secretary shall prioritize awarding grants
under this section that will serve the following areas:
``(1) Areas with a critical shortage of county or Tribal
veterans service officers.
``(2) Areas with high rates of--
``(A) suicide among veterans; or
``(B) referrals to the Veterans Crisis Line.
``(g) Use of County or Tribal Veterans Service Officers.--A State
or Indian Tribe that receives a grant under this section to carry out
an activity described in subsection (b)(1) shall carry out the activity
through--
``(1) a county or Tribal veterans service officer of the
State; or
``(2) if the State or Indian Tribe does not have a county
or Tribal veterans service officer, or if the county or Tribal
veterans service officers of the State or Indian Tribe cover
only a portion of that State or Indian Tribe, an appropriate
entity of a State, local, or Tribal government, as determined
by the Secretary.
``(h) Required Activities.--Any grant awarded under this section
shall be used--
``(1) to expand existing programs, activities, and
services;
``(2) to hire new, additional county or Tribal veterans
service officers; or
``(3) for travel and transportation to facilitate carrying
out paragraph (1) or (2).
``(i) Authorized Activities.--A grant under this section may be
used to provide education and training, including on-the-job training,
for State, county, local, and Tribal government employees who provide
(or when trained will provide) covered outreach services in order for
those employees to obtain accreditation in accordance with procedures
approved by the Secretary.
``(j) Outcome Measures.--(1) The Secretary shall develop and
provide to each State or Indian Tribe that receives a grant under this
section written guidance on the following:
``(A) Outcome measures.
``(B) Policies of the Department.
``(2) In developing outcome measures under paragraph (1), the
Secretary shall consider the following goals:
``(A) Increasing the use of veterans and veterans-related
benefits, particularly among vulnerable populations.
``(B) Increasing the number of county and Tribal veterans
service officers recognized by the Secretary for the
representation of veterans under chapter 59 of this title.
``(k) Tracking Requirements.--(1) With respect to each grant
awarded under this section, the Secretary shall track the use of
veterans and veterans-related benefits among the population served by
the grant, including the average period of time between the date on
which a veteran applies for such a benefit and the date on which the
veteran receives the benefit, disaggregated by type of benefit.
``(2) Not less frequently than annually during the life of the
grant program established under this section, the Secretary shall
submit to Congress a report on--
``(A) the information tracked under paragraph (1);
``(B) how the grants awarded under this section serve the
unique needs of American Indian veterans, Alaska Native
veterans, or Native Hawaiian veterans, elderly veterans, and
veterans from other underserved communities; and
``(C) other information provided by States and Indian
Tribes pursuant to the grant reporting requirements.
``(l) Performance Review.--The Secretary shall--
``(1) review the performance of each State or Indian Tribe
that receives a grant under this section; and
``(2) make information regarding such performance publicly
available.
``(m) Remediation Plan.--(1) In the case of a State or Indian Tribe
that receives a grant under this section and does not meet the outcome
measures developed by the Secretary under subsection (j), the Secretary
shall require the State or Indian Tribe to submit a remediation plan
under which the State shall describe how and when it plans to meet such
outcome measures.
``(2) The Secretary may not award a subsequent grant under this
section to a State or Indian Tribe described in paragraph (1) unless
the Secretary approves the remediation plan submitted by the State or
Indian Tribe.
``(n) Definitions.--In this section:
``(1) The term `county or Tribal veterans service officer'
includes a local equivalent veterans service officer.
``(2) The term `covered outreach' means outreach with
respect to--
``(A) benefits administered by the Under Secretary
for Benefits; or
``(B) similar benefits administered by a State or
Indian Tribe.
``(3) The term `Indian Tribe' has the meaning given such
term in section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 5304).
``(4) The term `State' includes the District of Columbia,
the Commonwealth of Puerto Rico, the Commonwealth of the
Northern Mariana Islands, and any territory or possession of
the United States.
``(5) The term `Veterans Crisis Line' means the toll-free
hotline for veterans established under section 1720F(h) of this
title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 63 of such title is amended by striking the items relating to
sections 6307 and 6308 and inserting the following new items:
``6307. Grants to States and Indian Tribes to improve outreach to
veterans
``6308. Outreach for eligible dependents
``6309. Biennial report to Congress''.
(c) Authorization of Appropriations.--There is authorized to be
appropriated to the Secretary of Veterans Affairs for each of fiscal
years 2025 and 2026, $10,000,000 to carry out section 6307 of title 28,
United States Code, as added by subsection (a).
SEC. 303. DEFINITION OF SURVIVING SPOUSE.
Paragraph (3) of section 101 of title 38, United States Code, is
amended to read as follows:
``(3) The term `surviving spouse' means (except for purposes of
chapter 19 of this title) a person who was the spouse of a veteran at
the time of the veteran's death, and who lived with the veteran
continuously from the date of marriage to the date of the veteran's
death (except where there was a separation which was due to the
misconduct of, or procured by, the veteran without the fault of the
spouse) and who has not remarried.''.
SEC. 304. ENSURING ONLY LICENSED HEALTH CARE PROFESSIONALS PERFORM
MEDICAL DISABILITY EXAMINATIONS UNDER CERTAIN DEPARTMENT
OF VETERANS AFFAIRS PILOT PROGRAM.
(a) Prohibition on Use of Certain Health Care Professionals.--
Section 504(c)(1) of the Veterans' Benefits Improvements Act of 1996
(Public Law 104-275; 38 U.S.C. 5101 note) is amended by inserting
``only'' before ``a health care professional''.
(b) Remedies.--The Secretary of Veterans Affairs shall take such
actions as the Secretary considers appropriate to ensure compliance
with section 504(c) of the Veterans' Benefits Improvements Act of 1996
(Public Law 104-275; 38 U.S.C. 5101 note), as amended by subsection
(a).
(c) Annual Report.--Not later than one year after the date of the
enactment of this Act and not less frequently than once each year
thereafter, the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of the
House of Representatives a report on--
(1) the conduct of the pilot program established under
section 504 of the Veterans' Benefits Improvements Act of 1996
(Public Law 104-275; 38 U.S.C. 5101 note); and
(2) the actions of the Secretary under subsection (b).
(d) Technical Corrections.--Section 504 of the Veterans' Benefits
Improvements Act of 1996 (Public Law 104-275; 38 U.S.C. 5101 note) is
amended, in the section heading, by striking ``physicians'' and
inserting ``health care professionals''.
SEC. 305. PROVISION OF INFORMATION REGARDING AN AGENT OR ATTORNEY TO A
LICENSED HEALTH CARE PROFESSIONAL WHO PERFORMS A MEDICAL
DISABILITY EXAMINATION UNDER CERTAIN DEPARTMENT OF
VETERANS AFFAIRS PILOT PROGRAM.
(a) In General.--Section 504 of the Veterans' Benefits Improvements
Act of 1996 (Public Law 104-275; 38 U.S.C. 5101 note), as amended by
section 304, is further amended by adding at the end the following new
subsection:
``(f) Certain Information Provided to Health Care Professional.--
The Secretary shall provide to a health care professional who performs
an examination under subsection (a) the contact information of any
agent or attorney recognized by the Secretary under chapter 59 of title
38, United States Code, with regards to a claim for benefits that gives
rise to such examination.''.
(b) Applicability.--The amendment made by this section shall apply
to an examination described in subsection (a) of such section that is
performed on or after the date of the enactment of this Act.
SEC. 306. MODERNIZATION OF DEPARTMENT OF VETERANS AFFAIRS DISABILITY
BENEFIT QUESTIONNAIRES.
(a) Requirement for Transmission of Certain Information in Machine-
Readable Format.--
(1) Requirement.--Not later than 180 days after enactment
of this Act, the Secretary of Veterans Affairs shall require
all disability benefit questionnaire data collected in the
course of medical disability examinations made by covered non-
Department providers to be transmitted to the Department in a
machine-readable format.
(2) Issuance of standards.--Not later than 90 days after
the date of the enactment of this Act, the Secretary shall
issue standards for the transmission of disability benefit
questionnaire data in a machine-readable format as required
under paragraph (1).
(3) Updates.--In making updates to disability benefit
questionnaires after the date specified in paragraph (1), the
Secretary shall--
(A) ensure that the updates are made in a manner
that allows for the data collected under the
questionnaires to be in a machine-readable format as of
the date on which the update goes into effect; and
(B) not later than 30 days before an update goes
into effect, notify the covered non-Department
providers (or their employers) described in such
paragraph of such updates.
(b) Plan for Information Technology System Modification.--Not later
than 180 days after the date of the enactment of this Act, the
Secretary shall submit to the Committees on Veterans' Affairs of the
Senate and the House of Representatives a plan to modify the
information technology systems and processes of the Department to
enable a non-Department health care professional, assigned to or
selected by a claimant, to transmit to the Department, in a machine-
readable format, disability benefit questionnaire data, including
complete disability benefit questionnaires rather than partial
questionnaires or elements of medical evidence.
(c) Public Availability of Information.--The Secretary shall make
publicly available on the internet website of the Department referred
to in section 5101(d) of title 38, United States Code--
(1) a description of the standards issued under subsection
(a)(2); and
(2) the plan required under subsection (b).
(d) Definitions.--In this section:
(1) The term ``claimant'' has the meaning given such term
in section 5100 of title 38, United States Code.
(2) The term ``covered non-Department provider'' means a
health care provider who--
(A) is not an employee of the Department of
Veterans Affairs; and
(B) pursuant to a contract under section 504 of the
Veterans Benefits Improvement Act of 1996 (Public Law
104-275; 38 U.S.C. 5101 note), as amended by sections
304 and 305, examines a claimant for a medical
disability.
SEC. 307. DEPARTMENT OF VETERANS AFFAIRS AUTOMATIC PROCESSING OF
CERTAIN CLAIMS FOR TEMPORARY DISABILITY RATINGS.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall modify
the information technology systems of the Department of Veterans
Affairs to use automation technology for claims for temporary
disability ratings for veterans described in section 1156(a)(1)(C) of
title 38, United States Code.
(b) Additional Requirements.--In providing for the automatic
processing of claims as required under subsection (a), the Secretary
shall ensure that--
(1) medical evidence is obtained from the corporate data
warehouse of the Department or other sources of data, the
Secretary determines appropriate;
(2) employees of the Department continue to determine
whether a veteran is entitled to a temporary disability rating
under section 1156(a)(1)(C) of title 38, United States Code;
and
(3) claims may be processed manually if the evidence of
record is not sufficient to decide the claim or if the medical
evidence is provided in a format that is not compatible with
the system developed under subsection (a).
TITLE IV--HOMELESSNESS MATTERS
SEC. 401. SHORT TITLE.
This title may be cited as the ``Housing our Military Veterans
Effectively Act of 2023'' or the ``HOME Act of 2023''.
SEC. 402. PER DIEM PAYMENTS PROVIDED BY THE SECRETARY OF VETERANS
AFFAIRS FOR SERVICES FURNISHED TO HOMELESS VETERANS.
(a) In General.--Section 2012 of title 38, United States Code, is
amended--
(1) in subsection (a)--
(A) in paragraph (2)(B)--
(i) in clause (i)(II)(aa)(BB), by striking
``115 percent'' and inserting ``115 percent
(or, during the period beginning on the date of
the enactment of the the Senator Elizabeth Dole
21st Century Veterans Healthcare and Benefits
Improvement Act and ending on September 30,
2026, 133 percent)''; and
(ii) by adding at the end the following:
``(iii) For each of fiscal years 2024 through 2026, the Secretary
may waive the maximum rate for per diem payments under clause
(i)(II)(aa)(BB) or (ii) and, subject to the availability of
appropriations, provide such payments at a rate that does not exceed
200 percent of the rate authorized for State homes for domiciliary care
under subsection (a)(1)(A) of section 1741 of this title, as the
Secretary may increase from time to time under subsection (c) of that
section, if the Secretary notifies Congress of such waiver.
``(iv) The Secretary may not, pursuant to clause (iii), waive the
maximum rate described in such clause for more than 50 percent of all
grant recipients and eligible entities for a fiscal year.''; and
(B) by adding at the end the following new
paragraph:
``(4) The Secretary may not provide more than 12,000 per diem
payments under this section for a fiscal year.''; and
(2) by adding at the end the following new subsection:
``(f) Reports Required.--Not later than 90 days after the date of
the enactment of the HOME Act of 2023, and not less frequently than
twice each year thereafter, the Secretary shall submit to the Committee
on Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a report on the rate for per
diem payments under this section that includes, for each Veterans
Integrated Service Network of the Department, the following data:
``(1) The average rate for such a payment.
``(2) A list of locations where the rate for such a payment
is within 10 percent of the maximum rate for such a payment
authorized under this section.
``(3) The average length of stay by a veteran participating
in a program described in section 2012(a) of this title.''.
(b) Regulatory Authority.--The Secretary of Veterans Affairs may
prescribe interim guidance to carry out the amendments made by
subsection (a).
(c) Strategic Plan.--
(1) In general.--Not later than the end of fiscal year
2025, the Secretary of Veterans Affairs shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee
on Veterans' Affairs of the House of Representatives a
strategic plan for the provision of grants and per diem
payments for services furnished to homeless veterans under
sections 2011 and 2012 of title 38, United States Code.
(2) Elements.--The plan required by paragraph (1) shall
include the following:
(A) A method for administering grant funding
equitably without using the rate authorized for State
homes for domiciliary care under subsection (a)(1)(A)
of section 1741 of title 38, United States Code, as the
Secretary may increase from time to time under
subsection (c) of that section, that takes into
account--
(i) the wide variety of services furnished
by grant recipients and eligible entities under
sections 2011 and 2012 of title 38, United
States Code;
(ii) varying costs of living across
different geographic locations;
(iii) varying availability of affordable
housing in different geographic locations;
(iv) circumstances of housing insecurity in
rural and Tribal communities;
(v) veterans with significant medical care
needs; and
(vi) the changing dynamic of the veteran
population nationwide.
(B) A plan and timeline for implementation of the
method included under subparagraph (A).
(C) An estimate of increased costs or savings per
year under the plan.
(D) An overview of the different grants that will
be available once the plan is implemented.
SEC. 403. AUTHORIZATION FOR SECRETARY OF VETERANS AFFAIRS TO USE OF
CERTAIN FUNDS FOR IMPROVED FLEXIBILITY IN ASSISTANCE TO
HOMELESS VETERANS.
(a) Use of Funds.--During the period beginning on the date of the
enactment of this Act and ending on the termination date specified in
subsection (d), the Secretary of Veterans Affairs may provide to a
covered veteran, as the Secretary determines necessary--
(1) food, shelter, clothing, blankets, and hygiene items
required for the safety and survival of the veteran;
(2) transportation required to support the stability and
health of the veteran for appointments with service providers,
the conduct of housing and employment searches, and the
obtainment of food and supplies; and
(3) tablets, smartphones, disposable phones and other
technology, and related service plans required to support the
stability and health of the veteran through the maintenance of
contact with service providers, prospective landlords, and
family members.
(b) Homeless Veterans on Department of Veterans Affairs Land.--
(1) In general.--The Secretary may collaborate, to the
extent practicable, with one or more organizations to manage
the use of land of the Department of Veterans Affairs for
homeless veterans for living and sleeping.
(2) Forms of collaboration.--Collaboration under paragraph
(1) may include the provision by either the Secretary or the
head of the organization concerned of food services and
security for property, buildings, and other facilities owned or
controlled by the Department of Veterans Affairs.
(c) Report Required.--Not later than six months after the date of
the enactment of this Act, and annually thereafter until the date
specified in subsection (d), the Secretary shall submit to Congress a
report that includes, with respect to the period covered by such
report--
(1) a statement, disaggregated by each medical center of
the Department of Veterans Affairs, of the amount of funds
under this section--
(A) each such medical center requested from the
Secretary; and
(B) to which the Secretary provided each such
medical center;
(2) data, disaggregated by each such medical center,
relating to how each such medical center used amounts provided
by the Secretary under this section;
(3) the number of covered veterans to which the Secretary
provided assistance under this section;
(4) the total amount of assistance the Secretary provided
to covered veterans pursuant to subsection (a)(3) for
communications equipment, broken down by the type of equipment
provided;
(5) the total amount of assistance the Secretary provided
covered veterans pursuant to subsection (a)(2) for ridesharing;
(6) the number of covered veterans who received such
assistance; and
(7) a description, for each rideshare used by a covered
veteran with such assistance, of the reasons such covered
veteran used such rideshare;
(8) the number of covered veterans who lived or slept on
Department land;
(9) the amount of funds used to make available Department
land for covered veterans to live and sleep;
(10) the number of Department employees whose primary
responsibilities involved providing services for covered
veterans living or sleeping on Department land;
(11) the average length of time a covered veteran lived or
slept on Department land; and
(12) the period of time the Secretary expects Department
land will be made available for covered veterans to live and
sleep.
(d) Termination Date.--The termination date specified in this
subsection is September 30, 2026.
(e) Definitions.--In this section, the term ``covered veteran''
means--
(1) a homeless veteran, as such term is defined in section
2002 of title 38, United States Code; and
(2) a veteran participating in the program carried out
under section 8(o)(19) of the United States Housing Act of 1937
(42 U.S.C. 1437f(o)(19)).
SEC. 404. ACCESS TO DEPARTMENT OF VETERANS AFFAIRS TELEHEALTH SERVICES.
(a) In General.--Subtitle VII of chapter 20 of title 38, United
States Code is amended by adding at the end the following new section:
``Sec. 2069. Access to telehealth services
``To the extent practicable, the Secretary shall ensure that
veterans participating in or receiving services from a program under
this chapter have access to telehealth services to which such veterans
are eligible under the laws administered by the Secretary, including by
ensuring that telehealth capabilities are available to--
``(1) such veterans;
``(2) case managers of the Department of programs for
homeless veterans authorized under this chapter; and
``(3) community-based service providers for homeless
veterans receiving funds from the Department through grants or
contracts.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 20 of title 38, United States Code, is amended by adding at the
end the following new item:
``2069. Access to telehealth services.''.
TITLE V--ELECTRONIC HEALTH RECORD MATTERS
SEC. 501. SHORT TITLE.
This title may be cited as the ``Electronic Health Record Program
Restructure, Enhance, Strengthen, and Empower Technology Act of 2024''
or the ``EHR Program RESET Act of 2024''.
SEC. 502. DEFINITIONS.
In this title:
(1) The term ``appropriate congressional committees''
means--
(A) the Committee on Veterans' Affairs and the
Committee on Appropriations of the House of
Representatives; and
(B) the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate.
(2) The term ``Electronic Health Record Modernization
Program'' means any activities being carried out, as of the
date of the enactment of this Act, by the Department of
Veterans Affairs to procure and implement an electronic health
record system to replace significant medical functions or
applications of the Veterans Information Systems and Technology
Architecture.
(3) The term ``other health information technology
activities and systems of the Department'' means health
information technology activities and systems other than
electronic health record systems, including functions
supporting clinical care or functional requirements,
notwithstanding the Determination and Findings executed by the
Secretary of Veterans Affairs on June 1, 2017.
(4) The term ``preliminary program activity'' means an
activity under the Electronic Health Record Modernization
Program, including any local workshop, training, testing, or
any other activity that is a direct precursor to the activation
of the electronic health record system at a particular Veterans
Health Administration facility.
Subtitle A--Electronic Health Record System and Health Information
Technology Modernization
SEC. 511. MODERNIZATION OF DEPARTMENT OF VETERANS AFFAIRS ELECTRONIC
HEALTH RECORD SYSTEM AND HEALTH INFORMATION TECHNOLOGY.
(a) In General.--The Secretary of Veterans Affairs is authorized to
carry out a program to modernize--
(1) the electronic health record system of the Department
of Veterans Affairs, either by making changes to the Electronic
Health Record Modernization Program, as in effect on the date
of the enactment of this Act, or by establishing a new program;
and
(2) other health information technology activities and
systems of the Department.
(b) Purpose of Modernization Program.--If the Secretary carries out
a program under subsection (a), some combination of the components of
such program as described in paragraphs (1) and (2) of subsection (a)
shall be designed to fulfill the following purposes:
(1) To improve the quality of hospital care, medical
services, and nursing home care furnished by the Department of
Veterans Affairs, including--
(A) by improving the delivery of care consistent
with quality and safety standards of the Department;
(B) by improving the coordination of such care and
services for such patients; and
(C) by improving timely access to such care and
services for such patients;
(2) To increase the productivity, efficiency, and
satisfaction of employees of the Veterans Health
Administration.
(3) To improve the experience of patients enrolled in the
patient enrollment system of the Department of Veterans Affairs
under section 1705 of title 38, United States Code.
(4) To reduce unnecessary variation in care delivery.
(5) To improve the quality, consistency, and management
of--
(A) data created or received by the Veterans Health
Administration, including such data related to or
needed for benefits determinations by the Department;
and
(B) data generated by or exchanged with a health
care provider through which the Secretary furnishes
such care and services under the laws administered by
the Secretary.
(6) To increase the interoperability of the electronic
health record systems and health information technology systems
of the Department by--
(A) expressing the content and format of health
data using a common language to improve the exchange of
data within and outside the Department;
(B) ensuring that Department medical personnel have
access to integrated, computable, and comprehensive
health records and health data of patients sufficient
to enable the provision of seamless care within and
outside the Department;
(C) surpassing the capabilities achievable through
bidirectional information exchange between electronic
health record systems or the exchange of read-only
data; and
(D) planning for and effectuating the broadest
possible implementation of interoperability and data
standards, specifically with respect to the Fast
Healthcare Interoperability Resources standard or
successor standard, the evolution of such standards,
and the obsolescence of such standards.
(7) To increase the amount of medical collections in the
Department of Veterans Affairs Medical Care Collections Fund
established under section 1729A of title 38, United States
Code.
(8) To support and strengthen research and development
activities, including such activities required under section
7303 of title 38, United States Code.
(9) To protect the personal information, including
personally identifiable information and protected health
information, of veterans, patients, and other users of
electronic health record systems and health information
technology systems authorized under subsection (a) from cyber
attacks, identity theft, and other cyber and security threats.
(10) Such other purposes as the Secretary may determine
appropriate.
SEC. 512. RESPONSIBILITY FOR ELECTRONIC HEALTH RECORD PROGRAM AND
HEALTH INFORMATION TECHNOLOGY.
(a) In General.--If the Secretary of Veterans Affairs carries out a
program under subsection (a) of section 511--
(1) with respect to the modernization of the electronic
health record system of the Department of Veterans Affairs
pursuant to section 511(a)(1)--
(A) the Deputy Secretary of Veterans Affairs
shall--
(i) be directly responsible to the
Secretary for such electronic health record
system modernization;
(ii) oversee such electronic health record
system modernization;
(iii) direct resources, subject to the
availability of appropriations, to the Office
of Information and Technology, the Veterans
Health Administration, or other organizational
subdivisions of the Department to facilitate
such modernization;
(iv) designate officials and offices within
the Department as operationally responsible for
such modernization, including a Program
Executive Director for Electronic Health Record
Modernization; and
(v) coordinate with the Under Secretary of
Veterans Affairs for Health and the Assistant
Secretary of Veterans Affairs for Information
and Technology;
(B) the Under Secretary for Health shall--
(i) have primary responsibility for
determining strategy and objectives of such
modernization;
(ii) exercise responsibility for the
implementation and operation of any functions
assigned by the Deputy Secretary pursuant to
subparagraph (D);
(iii) coordinate with the Deputy Secretary,
the Program Executive Director designated
pursuant to subparagraph (A)(iv), and the
Assistant Secretary for Information and
Technology;
(C) the Assistant Secretary for Information and
Technology shall--
(i) be responsible for carrying out the
information technology activities of the
Department in accordance with--
(I) section 310 of title 38, United
States Code;
(II) chapter 35 of title 44, United
States Code; and
(III) subtitle III of title 40,
United States Code;
(ii) exercise responsibility for the
implementation and operation of any functions
assigned by the Deputy Secretary pursuant to
subparagraph (D);
(iii) coordinate with the Deputy Secretary,
the Program Executive Director designated
pursuant to subparagraph (A)(iv), and the Under
Secretary for Health; and
(D) the Deputy Secretary, in consultation with the
Under Secretary for Health and the Assistant Secretary
for Information and Technology, shall determine the
distribution or assignment of responsibilities among
the Under Secretary for Health, the Assistant Secretary
for Information and Technology, and the Program
Executive Director designated pursuant to subparagraph
(A)(iv) for--
(i) defining and elaborating requirements;
(ii) implementation schedule;
(iii) system design and configuration;
(iv) workflow;
(v) system usability;
(vi) change management;
(vii) training; and
(viii) other functions relevant to such
modernization; and
(2) with respect to the modernization of other health
information technology activities and systems of the Department
pursuant to section 511(a)(2)--
(A) the Under Secretary for Health and the
Assistant Secretary for Information and Technology
shall share primary responsibility, shall coordinate
with one another, and shall jointly--
(i) coordinate with any other relevant
organizational subdivisions of the Department
regarding the prioritization, investment in,
and deployment of health information technology
regarding such modernization; and
(ii) develop the health information
technology strategy and roadmap required under
section 537;
(B) the Assistant Secretary for Information and
Technology shall be responsible for carrying out the
information technology activities of the Department in
accordance with--
(i) section 310 of title 38, United States
Code;
(ii) chapter 35 of title 44, United States
Code; and
(iii) subtitle III of title 40, United
States Code; and
(C) The Under Secretary for Health, acting through
the Chief Digital Health Officer of the Department or a
successor or equivalent officer, shall coordinate the
activities and functions of the Veterans Health
Administration, including health informatics.
(b) Executive Director.--With respect to the Electronic Health
Record Modernization program and any program carried out pursuant to
section 511(a)(1), the Program Executive Director designated pursuant
to subsection (a)(1)(A)(iv) shall--
(1) exercise responsibility for the implementation and
operation of the functions assigned by the Deputy Secretary
pursuant to subsection (a)(1)(D);
(2) oversee work performed by contractors related to such
programs, in coordination with the Principal Executive Director
of the Office of Acquisition, Logistics, and Construction; and
(3) coordinate with the Under Secretary for Health, the
Assistant Secretary for Information and Technology, and any
other relevant organizational subdivisions of the Department.
SEC. 513. PROTECTION OF PERSONAL INFORMATION.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall--
(1) ensure that each covered contract includes, or is
modified to include, a clause prohibiting covered information
from being monetized, sold, or otherwise misused by any
contractor, including any subcontractor or affiliate thereof,
or other non-Department of Veterans Affairs entity; and
(2) issue a directive or other policy providing guidance to
employees and contractors of the Department on how to identify
the monetization, sale, or misuse of covered information in
order to ensure contractors are in compliance with clauses in
covered contracts included pursuant to paragraph (1).
(b) Definitions.--In this section:
(1) The term ``covered contract'' means a contract of the
Department of Veterans Affairs that provides for the handling
of covered information and is entered into--
(A) after the date of the enactment of this Act; or
(B) before the date of the enactment of this Act
and does not expire before the date of the enactment of
this Act.
(2) The term ``covered information''--
(A) means protected health information or
personally identifiable information, including such
information that has been anonymized; and
(B) includes information protected under--
(i) section 552a of title 5, United States
Code;
(ii) section 5701 or 7332 of title 38
United States Code;
(iii) parts 160, 161, and 164 of title 45,
Code of Federal Regulations; and
(iv) any other provision of law, as
determined by the Secretary.
Subtitle B--Implementation Requirements
SEC. 521. VETERANS HEALTH ADMINISTRATION WORKFLOW BASELINE.
(a) Establishment.--The Under Secretary of Veterans Affairs for
Health, shall--
(1) conduct an enterprise inventory of core clinical and
business processes relevant to the program described in section
511(a)(1), including all workflows underlying such processes
throughout the Veterans Health Administration;
(2) evaluate and compare the workflows referred to in
paragraph (1) against relevant health care industry best
practices and clinical practice guidelines; and
(3) establish a baseline of clinical workflows for the
Veterans Health Administration.
(b) Incorporation.--The Under Secretary for Health shall
incorporate the baseline established under subsection (a)(3) into the
program described in section 511(a)(1).
(c) Monitoring and Control of Variations.--The Under Secretary for
Health shall--
(1) establish a process to monitor and control variations
from the baseline established under subsection (a)(3); and
(2) evaluate progress relative to such baseline.
(d) Standards.--The Under Secretary for Health shall establish
national standards for the Veterans Health Administration, pertaining
to the implementation and adoption of the electronic health record
system, for--
(1) order sets;
(2) user roles;
(3) medical devices;
(4) system interfaces and connectivity of medical devices;
and
(5) any clinical process not described in subsection (a)
that the Under Secretary for Health determines appropriate.
SEC. 522. REQUIREMENTS FOR ELECTRONIC HEALTH RECORD SYSTEM
IMPLEMENTATION.
(a) Metrics.--
(1) Establishment.--Not later than 90 days after the date
of the enactment of this Act, the Secretary of Veterans
Affairs, acting through the Under Secretary of Veterans Affairs
for Health, shall establish standard health care quality
metrics for purposes of evaluating the provision of health care
during the implementation and adoption of the electronic health
record system. Such metrics shall--
(A) be uniform in composition;
(B) take into account relevant differences in size,
complexity, and market composition of facilities of the
Veterans Health Administration;
(C) incorporate the Strategic Analytics for
Improvement and Learning Value Model of the Department,
any other relevant methodology, or any successor
methodology; and
(D) reflect the purposes referred to in section
511(b).
(2) Strategic analytics for improvement and learning value
model.--Upon the enactment of this Act, the Secretary shall
continue making publicly available the results of the Strategic
Analytics for Improvement and Learning Value Model with respect
to all medical facilities where the electronic health record
system pursuant to the Electronic Health Record Modernization
Program is active.
(b) Limitation on Preliminary Program Activities at Certain
Facilities.--In the case of any medical facility of the Department
where, as of the date of the enactment of this Act, a preliminary
program activity has not been initiated or is not being carried out,
the Secretary may not carry out such an activity at such facility
before the date on which the Secretary submits to the appropriate
congressional committees certification that--
(1) each medical facility where the electronic health
record system pursuant to the Electronic Health Record
Modernization Program is active as of such date of enactment,
has met or exceeded the operational levels of such medical
facility prior to implementing such system with respect to
operational areas of the Department related to the purposes
described in paragraphs (1), (2), (3), and (7) of section
511(b); and
(2) includes data to support such certification.
(c) Limitation on Implementation of Electronic Health Record
Modernization Program.--The Secretary may not implement the electronic
health record system pursuant to the Electronic Health Record
Modernization Program at a Department medical facility where such
system is not active as of date of enactment unless--
(1) the Secretary has made the certification described in
subsection (b); and
(2) the Under Secretary for Health, in consultation with
the director of the facility, submits to the Secretary, and the
Secretary transmits to the appropriate congressional
committees, written certification that--
(A) the director has confidence that the build and
configuration of the electronic health record, as
proposed to be carried out at such medical facility,
are accurate and complete;
(B) the staff and infrastructure of such facility
are adequately prepared to receive such system;
(C) the facility and the Department have taken
appropriate action to mitigate any adverse effects of
the implementation of such system on health outcomes,
coordination of care, wait times, patient safety, or
veteran experience at such medical facility; and
(D) such system has demonstrated a sustained record
of achieving the contractual requirements for outage-
free time and incident-free time prior to such
certification.
SEC. 523. CONDITIONAL RESTRUCTURING OF ELECTRONIC HEALTH RECORD
MODERNIZATION PROGRAM.
(a) In General.--Beginning on the date that is two years after the
date of the enactment of this Act, the Secretary of Veterans Affairs
may not exercise any option periods or optional tasks or extend any
contracts to carry out the Electronic Health Record Modernization
Program, unless before the date that is two years after the date of
enactment of this Act--
(1) the Secretary submits to the appropriate congressional
committees a certification, including supporting data, that the
metrics described in section 522(a) show overall improvement in
each measurement period during the period beginning on the date
of the enactment of this Act and ending on the date on which
the certification under this paragraph is made; and
(2) the Secretary has made the certification described in
section 522(b).
(b) Rule of Construction.--Nothing in this section may be construed
to require the Secretary to terminate any contract, task order,
modification, or other similar instrument under the Electronic Health
Record Modernization Program before the expiration of the period of
performance of such contract, task order, modification, or other
similar instrument.
(c) Failure To Make Certifications.--In the event that each
certification referred to in paragraphs (1) and (2) of subsection (a)
is not made before the date that is two years after the date of the
enactment of this Act, not later than 180 days after the date that is
two years after the date of the enactment of this Act, the Secretary
shall either--
(1) ensure that each facility of the Veterans Health
Administration using the electronic health record system
implemented pursuant to the Electronic Health Record
Modernization Program reactivates and resumes using the
Veterans Health Information Systems and Technology Architecture
and the Computerized Patient Record System of the Department;
or
(2) if the Secretary has submitted the report on
alternative modernization strategies under section 536, select
and pursue a strategy included in the report.
Subtitle C--Reporting
SEC. 531. REPORT ON ADDITIONAL PURPOSES.
If the Secretary determines any purpose to be appropriate pursuant
to section 511(b)(10), not later than 30 days after the date of such
determination, the Secretary shall submit to the appropriate
congressional committees a report that includes a description of such
purpose.
SEC. 532. REPORTS ON BASELINE OF CLINICAL WORKFLOWS.
(a) Baseline.--Not later than 90 days after the date on which the
Secretary establishes a baseline of clinical workflows pursuant to
section 521(a)(3), the Secretary shall submit to the appropriate
congressional committees a report that includes an identification of
such baseline.
(b) Standards.--Not later than 90 days after the date on which the
Secretary establishes the national standards pursuant to section
521(d), the Secretary shall submit to the appropriate congressional
committees a report that describes such standards.
SEC. 533. REPORT ON HEALTH CARE QUALITY METRICS.
Not later than 90 days after the date on which the Secretary
establishes the health care quality metrics described in section
522(a), the Secretary shall submit to the appropriate congressional
committees a report that includes an identification of such metrics.
SEC. 534. REPORT ON SUPPORT STRATEGY FOR EXISTING SITES.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary shall submit to the appropriate
congressional committees a report on the strategy of the Department to
enable each medical facility of the Department where the electronic
health record system implemented pursuant to the Electronic Health
Record Modernization Program is active as of the date of enactment of
this Act to achieve full user adoption of the system and meet or exceed
the operational levels of such medical center prior to implementing
such system with respect to operational areas of the Department related
to the purposes described in paragraphs (1), (2), (3), and (7) of
section 511(b). Such report shall include an estimated budget, or
revisions to an existing budget, if any, for each such facility to
implement such strategy, including with respect to costs related to--
(1) training;
(2) additional staff;
(3) technical support;
(4) support contracts;
(5) mitigation strategies; and
(6) any other resources determined necessary by the
director of the facility.
(b) Input.--The report described in subsection (a) shall be
developed with input from the directors of each such medical facility
and the directors of each Veterans Integrated Service Network in which
each such medical facility is located.
SEC. 535. REPORT ON RESOURCES REQUIRED FOR FUTURE SITES.
Not later than 90 days before a medical facility is scheduled to
implement the electronic health record system pursuant to the
Electronic Health Record Modernization Program, the Secretary shall
submit to the appropriate congressional committees a report provided by
the director of the medical facility, in consultation with the chief of
staff of the medical facility and the director of the Veterans
Integrated Service Network in which such medical facility is located.
Such report shall include a detailed description of the resources
provided to the medical facility, and the estimated resources still
required, to implement such system successfully, including with respect
to--
(1) funding;
(2) training;
(3) additional staff;
(4) technical support;
(5) support contracts;
(6) mitigation strategies; and
(7) any other resources determined necessary by the
director of the facility.
SEC. 536. REPORT ON ALTERNATIVE MODERNIZATION STRATEGIES.
(a) In General.--Not later than one year after completing the
baseline required under section 521(a), the Secretary, in consultation
with the Under Secretary of Veterans Affairs for Health, the Executive
Director of the Electronic Health Record Modernization Program, and the
Assistant Secretary of Veterans Affairs for Information and Technology,
shall submit to the appropriate congressional committees a report that
includes a description of not fewer than two alternative strategies to
the Electronic Health Record Modernization Program to carry out the
program described in section 511(a) and the purposes described in
section 511(b) in the event that each of the certifications referred to
in paragraphs (1) and (2) of section 523(a) are not made.
(b) Alternative Strategies.--The alternative strategies included in
the report shall include--
(1) a strategy of modernizing the Veterans Health
Information Systems and Technology Architecture in conjunction
with other health information technology activities and
systems;
(2) a strategy of implementing a commercial electronic
health record system, other than the Electronic Health Record
Modernization Program, in conjunction with other health
information technology activities and systems; and
(3) any other strategy the Secretary determines
appropriate.
(c) Requirements.--For each alternative strategy included in the
report, the Secretary shall include--
(1) a description of how the strategy incorporates the
baseline required under section 521(a);
(2) an indication of what combination of an electronic
health record system and other health information technology
activities and systems will be used to fulfill the purposes
described in section 511(b);
(3) a notional schedule for the implementation of the
strategy;
(4) a preliminary life cycle cost estimate for the
implementation of the strategy, including what, if any, costs
incurred during the implementation of the Electronic Health
Record Modernization Program may be recovered or investments
made during the implementation of such program may be reused;
(5) an explanation of how the strategy, if implemented,
would achieve the purposes described in section 511(b);
(6) a description of any improvements in governance,
management, and oversight made by the Department or proposed to
be made with respect to a program to carry out an alternative
strategy;
(7) an analysis of the feasibility of implementing the
strategy;
(8) an analysis of the level of risk to taxpayers and the
Department to implement the strategy as well as strategies to
mitigate any such risks;
(9) an analysis of the strengths and weaknesses of the
strategy; and
(10) a description of how the electronic health record
system implemented pursuant to the Electronic Health Record
Modernization Program will be sustained, deprecated, and
replaced through implementation of the strategy.
SEC. 537. REPORT ON HEALTH INFORMATION TECHNOLOGY STRATEGY AND ROADMAP.
(a) In General.--Not later than 270 days after the date of the
enactment of this Act, the Chief Digital Health Officer, or any
successor officer of the Department of Veterans Affairs, in
coordination with the Assistant Secretary of Veterans Affairs for
Information and Technology, the Chief Acquisition Officer of the
Department of Veterans Affairs, and the Program Executive Director
designated pursuant to section 512(a)(1)(A)(iv) shall submit to the
appropriate congressional committees a report a containing a health
information technology strategy and roadmap.
(b) Contents of Report.--The report required under subsection (a)
shall include each of the following:
(1) A health information technology strategy presenting the
comprehensive approach of the Department and objectives to
identify, prioritize, procure and use health information
technology of the Department as well as interfaces with health
information technology of non-Department entities and
integration of such systems and interfaces to improve--
(A) health care quality;
(B) health care delivery and coordination,
including of interfaced medical devices;
(C) efficiency of the health business and
administrative functions; and
(D) research functions of the Department.
(2) Goals and measurable metrics to assess implementation
of the strategy described in paragraph (1) and the roadmap
described in paragraph (4).
(3) As assessment of the current state and desired future
state of the Department, including technical architecture,
enterprise processes, and systems integration with respect to
health information technology.
(4) A roadmap to implement the strategy described in
paragraph (1), consisting of--
(A) a revised governance model, to include
management and oversight responsibilities, to
holistically organize, prioritize, and invest in health
information technology initiatives of the Department,
regardless of funding source, while removing
duplication and fragmentation in such initiatives of
the Department;
(B) a timeline to implement and operationalize the
strategy described in paragraph (1);
(C) a description of the acquisition and
contracting strategies of the Department at the
national, regional, or local levels to be created or
modified to implement the strategy described in
paragraph (1); and
(D) a description of any human capital needs
required to implement the strategy and roadmap,
including qualifications or incentives to obtain such
needs.
(c) Update to Report.--Not later than 120 days after the first day
of the fiscal year after the fiscal year during which the report
required under subsection (a) is submitted, and annually thereafter
until the date specified in subsection (d), the Chief Digital Health
Officer shall submit to the appropriate congressional committees an
updated report that includes each of the following:
(1) An identification of any significant changes to the
strategy described in subsection (b)(1) or any of the elements
of the strategy.
(2) An assessment of the extent to which the goals
described in subsection (b)(2) have been achieved, including
supporting metrics and data.
(3) An assessment of the progress and milestones achieved
related to the timeline described in subsection (b)(4)(D).
(4) A description of any corrective actions to be taken in
response to failure to meet any goals or milestones.
(5) The budget and spending plan of the Department for
health information technology, including all relevant accounts,
for the fiscal year during which the updated report is
submitted and the next fiscal year.
(d) Termination Date.--The date specified in this subsection is the
date that is four years after the date on which the first update is
submitted under subsection (c).
SEC. 538. ANNUAL REPORT ON EFFORTS TO MAINTAIN VISTA ELECTRONIC HEALTH
RECORD SYSTEM.
(a) In General.--Not later than 120 days after the first day of
each fiscal year that begins after the date of the enactment of this
Act until the date specified in subsection (c), the Secretary shall
submit to the appropriate congressional committees a report on the
Veterans Information Systems and Technology Architecture.
(b) Contents of Report.--The report required by subsection (a)
shall include--
(1) the operation and maintenance costs and development and
enhancement costs for the most recent fiscal year that ended
before the date of the submission of the report;
(2) the planned operation and maintenance efforts and
development and enhancement efforts during the fiscal year
during which the report is submitted and subsequent fiscal
years;
(3) the projected operation and maintenance and development
and enhancement costs for the nine fiscal years following the
fiscal year during which the report is submitted;
(4) a list of modules, applications, or systems within the
Veterans Information Systems and Technology Architecture--
(A) that have been retired or have been, or are
planned to be, subsumed by other systems or
applications; or
(B) that the Department plans to retire during the
fiscal year or in a future fiscal year; or
(C) for which there is no plan to retire or
subsume;
(5) a list of applications or systems to be developed
within, significantly modernized, or integrated with, the
Veterans Information Systems and Technology Architecture during
the fiscal year during which the report is submitted or during
any future fiscal year;
(6) a list of current, scheduled activity and associated
costs towards achieving certification as a certified electronic
health record technology pursuant to the program under section
3001(c) of the Public Health Service Act (42 U.S.C. 300jj-
11(c)); and
(7) a report on the stability of the system, including--
(A) outage-free time;
(B) incident-free time; and
(C) user interruptions across all instances of the
Veterans Information Systems and Technology
Architecture during the two previous fiscal years.
(c) Termination.--The date specified in this subsection is the date
that is 10 years after the date of the enactment of this Act.
SEC. 539. MODIFICATION OF QUARTERLY REPORTS.
Section 503 of the Veterans Benefits and Transition Act of 2018
(Public Law 115-407) is amended--
(1) in subsection (b)--
(A) by redesignating paragraphs (1) through (6) as
subparagraphs (A) through (F), respectively;
(B) in the matter preceding subparagraph (A), as
redesignated by paragraph (1), by striking ``Not later
than 30 days'' and inserting the following:
``(1) In general.--Not later than 30 days''; and
(C) by adding at the end the following:
``(2) Additional matters to be included.--The Secretary
shall include with any update submitted under paragraph (1) on
or after the date of enactment of the the Senator Elizabeth
Dole 21st Century Veterans Healthcare and Benefits Improvement
Act with respect to the quarter covered by the report, the
following:
``(A) Data on user adoption and employee
satisfaction with the electronic health record system
implemented pursuant to the Electronic Health Record
Modernization program or successor system implemented
pursuant to section 511(a)(1) of the the Senator
Elizabeth Dole 21st Century Veterans Healthcare and
Benefits Improvement Act, including training on such
system, using surveys of the Department and surveys
conducted for the Department.
``(B) Data on employee retention and turnover at
medical facilities where such electronic health record
system is in use.
``(C) Data on downtime, performance disruptions, or
impaired functionality of such electronic health record
system including--
``(i) cause;
``(ii) length;
``(iii) responsible entity; and
``(iv) corrective actions planned or taken.
``(D) Data on the impact of such system on revenue
and collections at medical facilities where such
electronic health record system is in use, including--
``(i) planned revenue and collections;
``(ii) actual revenue and collections; and
``(iii) steps planned or taken to achieve
planned revenue and collections.
``(E) Data on ticket resolution.
``(F) A list of any credits, reimbursements, or
monies provided by a contractor under the Electronic
Health Record Modernization program or invoice
deductions or withholdings taken by the Department from
such contractor in the reporting period to include due
to failure to meet the terms of a service level
agreement or other terms and conditions of the
contract.''; and
(2) in subsection (d)(2)(C)--
(A) by striking ``or dispute, and'' and inserting
``dispute, cure notice, letter of concern, or other
official communication by the Department to a
contractor concerning contract noncompliance or
corrective action, the official response of the
contractor, and''; and
(B) by striking ``or dispute (as'' and inserting
``dispute, cure notice, letter of concern, or other
official communication concerning contract
noncompliance and the official response of the
contractor (as''.
SEC. 540. REPORT ON PROTECTION OF PERSONAL INFORMATION.
Not later than one year after the date of the enactment of this
Act, the Secretary of Veterans Affairs shall submit to the appropriate
congressional committees a report that includes--
(1) a copy of the contract clause required by section
513(a);
(2) the guidance required by section 513(b); and
(3) a summary of any other actions taken to comply with
section 513.
SEC. 541. REPORT ON ORGANIZATION AND NEEDS.
(a) Congressional Notice Regarding Certain Actions.--
(1) In general.--Not later than 90 days after the date on
which an official of the Department of Veterans Affairs takes
an action specified in paragraph (2), the Secretary of Veterans
Affairs shall submit to the appropriate congressional
committees notice of such action.
(2) Action specified.--An action specified in this
paragraph is any of the following:
(A) The designation of any official or office by
the Deputy Secretary of Veterans Affairs pursuant to
section 512(a)(1)(A)(iv).
(B) The designation of any responsibility by the
Deputy Secretary pursuant to section 512(a)(1)(D).
(C) Any action related to the reorganization of a
program pursuant to section 511(a)(1) or (2).
(b) Report on Necessary Legislative Changes.--Not later than one
year after the date of the enactment of this Act, the Secretary shall
submit to the appropriate congressional committees a report that
includes a description of any legislative changes the Secretary
determines are necessary in order to carry out the responsibilities of
the Secretary with respect to the programs described in section
511(a)(1) or (2), regarding--
(1) organization;
(2) hiring or compensation authorities;
(3) appropriations; or
(4) related matters, as determined by the Secretary.
SEC. 542. REPORT ON GOVERNANCE, PERFORMANCE CRITERIA, AND READINESS.
Not later than 90 days after the date of the enactment of this Act,
the Secretary of Veterans Affairs shall submit to the appropriate
congressional committees a report describing the following:
(1) The clinical decision making structure of the
Department of Veterans Affairs and efforts to achieve a more
uniform clinical decision making structure, pertaining to the
Electronic Health Record Modernization Program, including--
(A) new service requirements;
(B) workflow decisions;
(C) change requests; and
(D) interface needs.
(2) The criteria or metrics used by the Secretary to
measure improvements in the Electronic Health Record
Modernization Program with respect to--
(A) end user experience;
(B) system stability;
(C) training;
(D) help desk ticket management; configuration; and
(E) any other criteria or metrics determined
appropriate by the Secretary.
(3) The most recent data reported pursuant to criteria or
metrics described in paragraph (2) from each facility of the
Veterans Health Administration using the electronic health
record system implemented pursuant to the Electronic Health
Record Modernization Program.
(4) A description of steps being taken by the Secretary to
achieve performance goals relevant to criteria or metrics
described in paragraph (2).
(5) The standard readiness task list used in facilities of
the Veterans Health Administration to prepare for
implementation of the electronic health record system pursuant
to the Electronic Health Record Modernization Program.
TITLE VI--OVERSIGHT AND INVESTIGATIONS MATTERS
SEC. 601. DEPARTMENT OF VETERANS AFFAIRS EMPLOYEE TRAINING REGARDING
OFFICE OF INSPECTOR GENERAL.
(a) Training.--The Secretary of Veterans Affairs shall require each
employee of the Department of Veterans Affairs who begins employment
with the Department on or after the date of the enactment of this Act
to receive training that the Inspector General of the Department shall
develop on the reporting of wrongdoing to, responding to requests from,
and the duty of cooperating with the Office of Inspector General of the
Department.
(b) Timing of Training.--In carrying out subsection (a), the
Secretary shall require each employee of the Department covered under
such subsection to undergo the training required by such subsection not
later than one year after the date on which the employee begins
employment with the Department.
(c) Elements.--Training developed and required under subsection (a)
shall include the following:
(1) Definition of the role, responsibilities, and legal
authority of the Inspector General of the Department and the
duties of employees of the Department for engaging with the
Office of Inspector General.
(2) Identification of Federal whistleblower protection
rights, including the right to report fraud, waste, abuse, and
other wrongdoing to Congress.
(3) Identification of the circumstances and mechanisms for
reporting fraud, waste, abuse, and other wrongdoing to the
Inspector General, including making confidential complaints to
the Inspector General.
(4) Identification of the prohibitions and remedies that
help to protect employees of the Department from retaliation
when reporting wrongdoing to the Inspector General.
(5) Recognition of opportunities to engage with staff of
the Office of Inspector General to improve programs,
operations, and services of the Department.
(6) Notification of the authority of the Inspector General
to subpoena the attendance and testimony of witnesses,
including former employees of the Department, as necessary to
carry out the duties of the Office of Inspector General under
section 312 of title 38, United States Code.
(d) Design and Update.--The Inspector General of the Department
shall design, and update as the Inspector General considers
appropriate, the training developed and required by subsection (a).
(e) System.--The Secretary shall provide, via the talent management
system of the Department, or successor system, the training developed
and required under subsection (a).
(f) Relation to Certain Training.--The Secretary shall ensure that
training developed and required under subsection (a) is separate and
distinct from training provided under section 733 of title 38, United
States Code.
(g) Notice to Employees.--The Secretary shall ensure that the
Inspector General is afforded the opportunity, not less frequently than
twice each year and more frequently if the Inspector General considers
appropriate under extraordinary circumstances, to use the electronic
mail system of the Department to notify all authorized users of such
system of the following:
(1) The roles and responsibilities of the employees of the
Department when engaging with the Office of Inspector General.
(2) The availability of training provided under subsection
(a).
(3) How to access training provided under subsection (a).
(4) Information about how to contact the Office of
Inspector General, including a link to any website-based
reporting form of the Office.
SEC. 602. ANNUAL REVIEW OF SECURITY AT COVERED FACILITIES OF THE
DEPARTMENT OF VETERANS AFFAIRS.
(a) Annual Survey.--Not later than one year after the date of the
enactment of this Act, and annually thereafter for each of the
following five fiscal years, the Secretary of Veterans Affairs, in
coordination with the Director of the Office of Security and Law
Enforcement of the Department of Veterans Affairs, shall conduct a
survey of the covered employees at each covered facility to collect
information regarding security. Each annual survey shall include
questions about--
(1) the type and frequency of criminal activity experienced
at the covered facility during the fiscal year which most
recently concluded including whether or not the criminal
activity was related to residents at the facility or campus
such as those in a residential rehabilitation treatment program
or enhanced-use lease facility;
(2) the number of vacancies and number of days vacant for
Department police officers at the covered facility at the time
of the survey delineated by recruitment status and stage;
(3) the availability and adequacy of covered equipment;
(4) the availability and adequacy of resources, classes, or
other time set aside for training Department police officers
who work at each covered facility about any skill or tactic
related to law enforcement, including the proper use of force,
firearms qualifications and training, procedures for responding
to an active threat, and any other training required for
Department police officers;
(5) any security weakness at covered facilities;
(6) the relationship between the covered facility
(including the Department police officers who work at the
covered facility) and local, state, and federal law enforcement
agencies including what agreements or memorandums of
understanding exist between each covered facility and external
law enforcement agencies;
(7) efforts by the personnel of the covered facility to
address and reduce criminal activity at, or in close proximity
to, the covered facility; and
(8) recommendations for the Secretary to better address and
reduce criminal activity at, or in close proximity to, covered
facilities so as to improve the safety of veterans, employees,
visitors, other authorized personnel, and the surrounding
community.
(b) Report.--Not later than 30 days after the end of the next full
Fiscal Year after the enactment of this Act and for each of the
following five fiscal years, the Secretary shall submit to each of the
Committees on Veterans' Affairs of the Senate and the House of
Representatives a report regarding the results of the surveys conducted
under subsection (a) during the previous fiscal year. The report shall
include--
(1) the results of the annual survey described under
subsection (a) for the year covered by the report;
(2) an analysis, made in coordination with the Director of
the Office of Security and Law Enforcement of such Department,
each director and police chief of a Veterans Integrated Service
Network, and the directors and police chiefs of the medical
centers within the Veterans Integrated Service Network of the
results of the triannual security inspections conducted in
prior fiscal year, to include a plan of action that describes
how the Secretary plans to address any security weakness
identified in the results of the triannual security inspections
and includes clearly-stated goals with measurable benchmarks
for each goal and deadlines for each benchmark; and
(3) a list of all vacant positions for police chief or
deputy police chief at each covered facility during the prior
fiscal year, the number of individuals who filled those
positions over the two years prior to the date of the survey,
the number of days the positions were vacant without someone
serving in an acting capacity, and the number of days the
positions were filled by individuals serving in an acting
capacity.
(c) Definitions.--In this section:
(1) The term ``covered equipment'' means any item issued by
the Secretary of Veterans Affairs to a Department police
officer (including firearms, weapons detecting technology,
ballistic vests, body-worn cameras, and radios) for use in the
provision of services under section 902 of title 38, United
States Code.
(2) The term ``covered employee'' means an employee of the
Department of Veterans Affairs who is employed and responsible
for security operations at a covered facility including a
covered facility's police chief, facility emergency management
leader, facility director, or person carrying out the
responsibilities of one of these positions in an acting
capacity.
(3) The term ``covered facility'' means any facility of the
Department of Veterans Affairs where Department police officers
have jurisdiction.
(4) The term ``Department police officer'' has the meaning
given to such term as used in section 902 of title 38, United
States Code.
(5) The term ``security weakness'' means a deficiency in
the facilities, staffing, or covered equipment at a covered
facility that a covered employee of the covered facility
determines presents a risk to the safety of visitors or staff,
including an unsecured door, inoperable security camera,
unsecured police operations room, a lack of security presence
at an entrance to the covered facility, and a lack of security
presence in an area of the covered facility or the grounds of
the covered facility that the director of the covered facility
determines requires an increased security presence.
SEC. 603. MODIFICATION OF CERTAIN HOUSING LOAN FEES.
The loan fee table in section 3729(b)(2) of title 38, United States
Code, is amended by striking ``November 15, 2031'' each place it
appears and inserting ``September 30, 2034''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Veterans' Affairs, and in addition to the Committees on Natural Resources, and Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Veterans' Affairs, and in addition to the Committees on Natural Resources, and Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Veterans' Affairs, and in addition to the Committees on Natural Resources, and Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Mr. Bost moved to suspend the rules and pass the bill, as amended.
Considered under suspension of the rules. (consideration: CR H6038-6070)
DEBATE - The House proceeded with forty minutes of debate on H.R. 8371.
At the conclusion of debate, the Yeas and Nays were demanded and ordered. Pursuant to the provisions of clause 8, rule XX, the Chair announced that further proceedings on the motion would be postponed.
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Considered as unfinished business. (consideration: CR H6071)
Passed/agreed to in House: On motion to suspend the rules and pass the bill, as amended Agreed to by the Yeas and Nays: (2/3 required): 389 - 9 (Roll no. 466). (text: CR H6038-6065)
Roll Call #466 (House)On motion to suspend the rules and pass the bill, as amended Agreed to by the Yeas and Nays: (2/3 required): 389 - 9 (Roll no. 466). (text: CR H6038-6065)
Roll Call #466 (House)Motion to reconsider laid on the table Agreed to without objection.
Received in the Senate.